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Affidavit of Incidence
Affidavit of Incidence
AFFIDAVIT OF INCIDENCE
I, MICHELLE B. DELA PAZ, of legal age, married, Filipino citizen, and a resident
of San Jose Cawa-Cawa, Zamboanga City, Philippines, after having been duly sworn in
accordance with law, hereby depose and say, that:
MAKE : Toyota
SERIES : FORTUNER 2.4L 4
ENGINE NO. : 2GDC414578
MV FILE NO : 0701-00000754832
CERTIFICATE OF REGISTRATION NO. : 323891551
OFFICIAL RECEIPT NO. : 1536781256
3. The damage caused upon the above-described motor-vehicle was not intentional
but purely of accidental cause;
4. I make these statements under oath and in good faith in order to establish the
fact that the damage caused was not intentional but purely of accidental cause;
5. I execute this Affidavit voluntarily to attest to the truth of the foregoing facts
based on personal knowledge and authentic records for purposes of Insurance
claim and other legal purposes it may serve.