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  • Affidavit - Accident

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    Pyke Laygo
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    1. Edgar Esguerra Ibanga was driving a vehicle owned by his employer, Geraldine Felipe Buncag, when a tricycle clipped the right side of the front bumper and right fender, causing damage. 2. The accident occurred on December 27, 2018 at 10:30 AM in Dinalupihan, Bataan while traversing JC Payumo St. 3. Mr. Ibanga did not cause or contribute to the accident in any way and is filing this affidavit to support an insurance claim to repair the damage to his employer's vehicle.

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    1. Edgar Esguerra Ibanga was driving a vehicle owned by his employer, Geraldine Felipe Buncag, when a tricycle clipped the right side of the front bumper and right fender, causing damage. 2. The accident occurred on December 27, 2018 at 10:30 AM in Dinalupihan, Bataan while traversing JC Payumo St. 3. Mr. Ibanga did not cause or contribute to the accident in any way and is filing this affidavit to support an insurance claim to repair the damage to his employer's vehicle.

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    131 views2 pages

    Affidavit - Accident

    Uploaded by

    Pyke Laygo
    1. Edgar Esguerra Ibanga was driving a vehicle owned by his employer, Geraldine Felipe Buncag, when a tricycle clipped the right side of the front bumper and right fender, causing damage. 2. The accident occurred on December 27, 2018 at 10:30 AM in Dinalupihan, Bataan while traversing JC Payumo St. 3. Mr. Ibanga did not cause or contribute to the accident in any way and is filing this affidavit to support an insurance claim to repair the damage to his employer's vehicle.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 2

    Republic of the Philippines )

    Province of Bataan ) S.S.


    Municipality of Orion )

    AFFIDAVIT OF DAMAGE TO VEHICLE

    I, EDGAR ESGUERRA IBANGA, of legal age, Filipino, married, and


    a resident of 74 Bisig, Valenzuela City, 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. NPO4-93-


    2891787 which is valid until 07/27/2022.

    2. That on 27 December 2018 at around 10:30 AM, while the car that I am
    driving was traversing JC Payumo St., Dinalupihan, Bataan which is
    owned by my employer, Geraldine Felipe Buncag, a tricycle has overtaken
    me on the right side and clipped the right side of the front bumper od said
    vehicle. It also caused damage to the right fender of said vehicle as well.
    The said tricycle speed away and I was not able to neither see its plate
    number nor remember the face of the driver.

    3. The vehicle that I am driving is owned and registered in the name of my


    employer, Geraldine Felipe Buncag and is more particularly described as
    follows:

    Model: Toyota Corolla Altis 2 2016


    Color: Metallic Grey
    Conduction Sticker No. YY1034
    MV File No: 1301--00000603842
    Engine No: 3ZRX557489
    Chassis No:MR053EH304504482
    Certificate of Registration No.: 244235165
    LTO Official Receipt: 909433840

    4. That although the same is an accident, I have not caused the same nor
    contributed to the event in any way possible.

    5. That I am executing this Affidavit to attest to the truth of the forgoing


    and in support of the claim with the insurer for the repair of the damage
    caused to the vehicle of my employer.

    IN WITNESS WHEREOF, I have hereunto set my hand this


    ______th day of ____________ 2019 in Orion, Bataan, Philippines.
    Page 2 of 2

    EDGAR ESGUERRA IBANGA


    Affiant

    SUBSCRIBED AND SWORN TO BEFORE ME this _____ th day of


    ________________ 2019 in Orion, Bataan, Philippines by affiant who
    presented his LTO Driver's License No. NPO4-93-2891787 which is valid
    until 07/27/2022.

    Doc. No. ___


    Page No. ___
    Book No. ___
    Series of 2019

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