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Driver's Affidavit Bernabe

Melvin F. Bernabe was driving home on November 8, 2019 when a stray dog suddenly crossed the street, causing him to accidentally hit it with his vehicle. The next morning, he discovered a long crack in the lower part of his vehicle's bumper from the accident. He has provided this sworn affidavit to attest to the details of the incident and accident in order to file an insurance claim for the damage to his vehicle.

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Kazper Bermejo
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158 views1 page

Driver's Affidavit Bernabe

Melvin F. Bernabe was driving home on November 8, 2019 when a stray dog suddenly crossed the street, causing him to accidentally hit it with his vehicle. The next morning, he discovered a long crack in the lower part of his vehicle's bumper from the accident. He has provided this sworn affidavit to attest to the details of the incident and accident in order to file an insurance claim for the damage to his vehicle.

Uploaded by

Kazper Bermejo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO . . . . . . . . . . . . . ) S.S.


X------------------------X

DRIVER’S AFFIDAVIT
I, MELVIN F. BERNABE, of legal age, married, and a resident of Villareal
St., Mambusao, Capiz, after having been sworn to in accordance with law
depose and say:

That on November 8, 2019 at about 5:00 p.m., I was on my way to Pavia


driving a motor vehicle described as follows:

Make: Mitsubishi Mirage Plate No.: B4 M560


Type: 4 Door Sedan Owned by: Melvin F. Bernabe

That while I was driving the aforementioned vehicle along the


circumferential road near the Municipality of Pavia, a brown stray dog suddenly
cross the street. As a result I accidentally hit the dog. I immediately stopped and
stepped out of the car and check for the dog. Fortunately, it is still alive. I made
an effort to locate the owner but to no avail. After that I leaved the dog at the side
of the road and I then went home.

That early in the morning the next day, when I was preparing the vehicle
going to my work, I found out that there is already a long crack at the lower part
of the bumper of the vehicle;

That I am executing this affidavit to attest to the foregoing truth and facts
of the incident; and

That I executed this affidavit to state the aforementioned facts under oath
for the purpose of filing a claim.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 11th


day of November 2019 in Iloilo City, Philippines.

MELVIN F. BERNABE
Affiant

SUBSCRIBED AND SWORN TO before me this 11th day of November


2019 at Iloilo City, Philippines, affiant exhibited to me his Driver’s License FO3-
13-002288 which will expire on July 18, 2023, as competent proof of his identity.

Doc. No. ________;


Page No. _______;
Book No. ________;
Series of 2019.

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