Affidavit of Damage to Vehicle – Hit-and-Run Sample Allegations

Affidavit of Damage to Vehicle – Hit-and-Run Sample Allegations

Learn everything you need to know about Employee Compensation and Benefits by Atty. Elvin Villanueva

Affidavit of Damage to vehicle is one of the required documents to claim insurance benefits for own damage and similar cases.

Below is the sample affidavit with allegations which may be necessary to establish the facts and formal requirements:


City of __________________________ ) S.S.


 I, JUAN DELA CRUZ, of legal age, and a resident of 1234 Matayog St., Dimakita Village, Makati City, after having been duly sworn to in accordance with law, do hereby depose and state that:

  1. I am an owner of a motor vehicle described as follows:

Make:             Chevrolet 2.8 Trailblazer 4×2

Model:            LTX

Plate No.:      WWERTT

Color:             Black

  1. Likewise, I am a holder of a non-professional driver’s license duly registered with the Land Transportation Office (LTO) with license number ___________________ with expiry date ________________;
  2. The incident happened last ____________, 20____, at 8:00 o’ clock in the evening at Malugay St., Makati City.
  3. I was reversing the vehicle when inadvertently the truck suddenly appeared behind me. Suddenly, I heard a loud sound at the left side portion of the vehicle.
  4. The truck sped away and I did not notice the plate number as I was focused on what might have happened behind the vehicle. I got down and checked the back portion of the car and saw the damage on the rear left side.
  • Picture of the damaged rear left side is hereto attached as Annex “A”;
  1. At the time of the accident, the above vehicle was duly registered with the LTO.
  • Copies of the OR/CR are hereto attached as Annex “C” and Annex “D”.
  1. I am executing this affidavit for purposes of insurance claim and to attest to the truth of the foregoing statements.

            IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of ___________, 20____ at Makati City, Philippines.


                                                                                 JUAN DELA CRUZ
                                                                          ID/Driver’s License: _______________


SUBSCRIBED AND SWORN TO BEFORE ME, this _____ day of ___________, 20____ personally appeared the above, exhibiting to me his competent evidence of identity his shown above.


Doc. No. _______________:

Page No. ______________:

Book No. ______________:

Series of 20____

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