Affidavit: IN WITNESS WHEREOF, I Have Hereunto Set My Hand This 29

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AFFIDAVIT

I, _____________________, Filipino, of legal age, and a resident of


____________________________________________, _____________, Philippines, after being
sworn to in accordance with law, depose and state:

1. That I am a duly licensed driver with Driver’s License No. _____________ covered by DLR
No.___________, which is valid until _________________.

2. That I am the true and registered owner of a certain motor vehicle, more particularly
described as follows:
Make: MV File No.:
Series: Chassis No.:
Body Type: Plate No.:
Year Model: Engine No.:

3. That on April 24, 2022, at around 4:40 in the Afternoon, I parked the said motor vehicle at Sta.
Clara de Montefalco Parish in Brgy. Caniogan, Pasig City.

4. That after more than an hour later, as a 5pm mass ended, when I returned to the said vehicle,
I was surprised as I arrived to find that there’s a noticeable damage on the right side rear of my
motor vehicle. There were huge scratches on it, its paintwork damaged and needs repair.

5. At that time it is noticeable that the church’s parking is almost full, that may explain that
there might be a passing car who accidentally scratched my car while getting off the parking lot.

7. That as I checked and investigate the place, no CCTV has been installed and no one witnessed
the incident. As I inquire with the parish administrator, they confirmed that the place where a
CCTV was installed is just in the entrance.

8. That I am executing this Affidavit to attest to the truth of the foregoing and in support of my
claim on the insurance of the said motor vehicle.

IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of April 2022 in
Pasig, City, Philippines.

_________________________
Affiant

SUBCRIBED and SWORN TO before me this ___________________ in


_________________, Philippines, affiant exhibiting to me her _____________________ as
competent evidence of identity.

WITNESS MY HAND AND SEAL on the date and place above-written.

NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022.

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