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Sworn Statement of No Insurance Claim

Arthur C. Dy, president of AG CANPRINT INC., swore in an affidavit that the company owns a Fuji Kikai oven machine but has made no insurance claims on it since purchase. He executed this sworn statement to confirm for the Bureau of Fire Protection that the company has no insurance on the oven machine.

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56 views

Sworn Statement of No Insurance Claim

Arthur C. Dy, president of AG CANPRINT INC., swore in an affidavit that the company owns a Fuji Kikai oven machine but has made no insurance claims on it since purchase. He executed this sworn statement to confirm for the Bureau of Fire Protection that the company has no insurance on the oven machine.

Uploaded by

Anonymous iB3xNi3v
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

MEYCAUAYAN, BULACAN )S.S.

SWORN STATEMENT OF NO INSURANCE CLAIM

I, ARTHUR C. DY., of legal age, Filipino, married and with postal address
atTombow Street, Sterling Industrial Park, Libtong, Meycauayan, Bulacan, hereby
deposes and states;

I am the President of AG CANPRINT, INCORPORATED, with office and


business address at Tombow Street, Sterling Industrial Park, Libtong, Meycauayan,
Bulacan.

That AG CANPRINT INC.is the owner of a Fuji Kikai oven machine;

That I do, hereby certify that I have no claim of insurance sustained by Fuji Kikai
oven machine under the company’s name since the day of its purchase.

That I am executing this Sworn Statement to attest the truth of the foregoing and
in support of the Bureau of Fire Protection’s requirement for the said machine oven.

AFFIANT FURTHER SAYETH NAUGHT.

ARTHUR C. DY
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ____________at


Valenzuela City, Philippines. Affiant exhibited to me his
__________________________ issued at _________________ on _________________.

Doc. No. _____;


Page No. ____;
Book No. ____;
Series of 2020.

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