REPUBLIC OF THE PHILIPPINES )
BACOOR CITY ) S.S.
x-----------------------------------------x
AFFIDAVIT
I, _________, of legal age, Filipino, single, and a resident of ________, after having been
duly sworn to in accordance with law, depose and state that:
1. I am the daughter of _________, the registered owner of the vehicle Toyota
Cross with Plate Number ________ (the “Vehicle”).
2. On February 15, 2023, at around 5:30am, I was driving alone along Ayala
Avenue after dropping off my sister, _________ at the Ayala 1 Terminal, when a
black sedan drove past me, hitting the right passenger side of the Vehicle.
Pictures of the damaged Vehicle is attached as Annex A.
3. Because I was too focused on driving, and as it was still a bit dark, I was
unable to note down the license plate number of the black sedan.
4. Due to the damage sustained by the accident, the Vehicle will have to be
repaired.
5. I am executing this affidavit to affirm the truth of the foregoing statements
and for whatever legal purpose it may serve me best.
IN WITNESS WHEREOF, this Affidavit has been signed on ___________________, 2023 in
the City of Bacoor, Philippines.
Affiant
REPUBLIC OF THE PHILIPPINES )
CITY OF BACOOR ) ss.
Before me, a notary public in and for the city named above, personally appeared:
Name Competent Evidence of Date/ Place of Issue
Identity
who was identified by me through competent evidence of identity to be the same
person described in the foregoing instrument and signed the instrument in my
presence, and who took an oath before me as to such instrument.
Witness my hand and seal this ________________ 2023.
Doc. No._____;
Page No. _____;
Book No. _____;
Series of 2023.
