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    Affidavit of Damage To Vehicle

    Uploaded by

    Grace Buenconsejo
    On July 5, 2021 at 7 PM, the affiant's vehicle was stuck in traffic in heavy rain when a motorcycle bumped her left rear bumper, causing scratches and disaligning the bumper. Due to the rain and traffic, the affiant was unable to see the motorist's plate number or pursue them.

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    © All Rights Reserved
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    Affidavit of Damage To Vehicle

    Uploaded by

    Grace Buenconsejo
    17 views2 pages
    On July 5, 2021 at 7 PM, the affiant's vehicle was stuck in traffic in heavy rain when a motorcycle bumped her left rear bumper, causing scratches and disaligning the bumper. Due to the rain and traffic, the affiant was unable to see the motorist's plate number or pursue them.

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    Affidavit of Damage to Vehicle

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    On July 5, 2021 at 7 PM, the affiant's vehicle was stuck in traffic in heavy rain when a motorcycle bumped her left rear bumper, causing scratches and disaligning the bumper. Due to the rain and traffic, the affiant was unable to see the motorist's plate number or pursue them.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    17 views2 pages

    Affidavit of Damage To Vehicle

    Uploaded by

    Grace Buenconsejo
    On July 5, 2021 at 7 PM, the affiant's vehicle was stuck in traffic in heavy rain when a motorcycle bumped her left rear bumper, causing scratches and disaligning the bumper. Due to the rain and traffic, the affiant was unable to see the motorist's plate number or pursue them.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    REPUBLIC OF THE PHILIPPINES )

    CITY OF MANILA )S.S.

    AFFIDAVIT OF DAMAGE
    TO VEHICLE

    I, Atty. MYRA JANINA P. BAÑAGA, Filipino, of legal age, single and with
    office address at 7th Floor 1000 A. Mabini corner T.M. Kalaw Streets,
    Ermita, City of Manila, after having been sworn under into law, hereby
    declare that:

    1. I am the owner of Motor Car Insurance Policy No. MC-PVSPL-


    M1-21-0002756-00 under The Mercantile Insurance Co., Inc., issued on
    14 May 2021 and with Policy Period from 21 June 2021 to 21 June 2022.
    The said Motor Car Insurance Policy is for my vehicle with the following
    details:

    Plate No.: NAV 1610


    Make/Series: Nissan Juke 1.6L CVT
    Year Model: 2017
    Engine No.: HR16089515D
    Chassis No.: JN1FBAF15z0403766
    OR No.: 2007693225
    CR No.: 281920914

    2. On 5 July 2021 at around 7:00PM, my vehicle was stuck in


    traffic and heavy rain along General Luis, Novaliches, Quezon City when I
    heard a loud bang behind me.

    3. When I looked at the rear-view mirror, a motorcycle bumped


    my left rear bumper, and caused scratches on my car and my bumper to
    be disaligned.

    4. Due to the torrential rain and the tinted windshield, windows


    and rear glass of my car, I did not see and could not take note of the
    motorist’s plate number, and he/she weeded in and out of traffic and
    escaped from liability. I was also not able to run after him/her due to the
    heavy traffic wherein my vehicle was stuck.

    5. I am executing this Affidavit to attest the foregoing facts for


    the purpose of securing a claim for my Motor Car Insurance Policy with
    The Mercantile Insurance Co., Inc. and for whatever legal purpose this
    may serve.

    Further, affiant sayeth naught.

    IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of


    July 2021 at the City of Manila, Philippines.

    ATTY. MYRA JANINA P. BAÑAGA


    Affiant
    2

    SUBSCRIBED AND SWORN TO BEFORE ME this 6th day of July 2021 at the
    City of Manila, Philippines, affiant exhibited to me her Roll of Attorneys
    No. 56879, bearing both her photograph and signature.

    Doc. No. ____;


    Page No. ____;
    Book No. ____;
    Series of 2021.

    On 5 July 2021 around 7:00PM along General Luis, Novaliches, Quezon City.
    On stop because of traffic, I heard a loud bang behind me, when I looked in a rear view mirror a
    motorcycle bumped my left rear bumper and caused scratches and my bumper to be dis-aligned.
    It was raining, I did not see his/her plate number, and weeded in and out of traffic and escaped
    from liability.  It was raining so it was hard for me to take note of his plate number. Because of
    traffic I was not able to run after him/her.

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