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    Affidavit of Damage Vehicle Additional

    Uploaded by

    Jojo Lubrica
    Affidavit of Damage Vehicle additional

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Affidavit of Damage Vehicle Additional

    Uploaded by

    Jojo Lubrica
    1 views1 page
    Affidavit of Damage Vehicle additional

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    Affidavit of Damage Vehicle additional

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    © © All Rights Reserved

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    Affidavit of Damage Vehicle additional

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    1 views1 page

    Affidavit of Damage Vehicle Additional

    Uploaded by

    Jojo Lubrica
    Affidavit of Damage Vehicle additional

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines)

    Province of Metro Manila ) S.S.

    City/Municipality of Quezon City)

    x------------x

    AFFIDAVIT OF DAMAGE TO VEHICLE

    I, JOSEPH NEVES LUBRICA, Filipino, of legal age, Married, and a resident of number 93 K-
    2nd Street, Barangay Kamuning Quezon City, Metro Manila, Philippines 1103 after being sworn to
    in accordance with law, depose and state:

    1. That I am a duly licensed driver with Driver's License No. N02-00-441331, which is valid until
    JUNE 18 2022.

    2. That on October 13, at around 12:00 in the afternoon, I was driving a vehicle owned and
    registered to Mrs. Maria Teresa Hufano Dela Cruz which is more particularly described as follows:

    Make: TOYOTA Engine / Motor No.: 1GD0196194


    Series: INNOVA Chassis No.: PA2JA8EM7G0011244
    Body Type: AUV Plate No.: NDD2704
    Color: Silver (thermalite) Conduction No. VK4127
    Year Model: 2017 MVRR No.: 1301-00000777005

    3. The vehicle was park at k-1st street beside Kamuning Bakery at Kamuning Quezon City when
    suddenly one of the branches fell off and hit the roof and windshield and some minor scratch at left
    door.

    4. That I am executing this Affidavit to attest to the truth of the forgoing and in support of the
    claim against the insurer for the repair of the damage caused to my vehicle

    IN WITNESS WHEREOF, I have hereunto set my hand this ________in ________, Philippines.

    JOSEPH NEVES LUBRICA

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