Vehicle Insurance Claim

Vehicle Insurance Claim free legal form

Use this free template – Vehicle Insurance Claim. This affidavit of insurance can be used for an accident between two motor vehicles.

To use this complimentary template, simply fill out the blank spaces and edit the document with the relevant information, print it out, and sign below.

I, ___________________________, of legal age, Filipino, ____________________, and presently residing at _____ _____________________________________, after having been duly sworn to in accordance with the law, depose and state:
I am the owner of a certain registered motor vehicle, which I inherited from my deceased father through intestate succession, with the particular description as follows, to wit:

MAKE: Honda

BODY: Sedan


MODEL: 1998


Serial/Chassis No.: US15- 2B3509

MV FILE No.: 2477- 33438

On 03 October 2013 at 2 o’clock in the afternoon, the said motor vehicle met an accident.

This had happened while I was parking in front of a hardware store between the two motor vehicles, at the left side was an elf van, and while at the right was a car. At that time, I was carefully looking at the car on my right, and I did not notice the elf van in the parking area. When I made a reverse turn, I hit the elf by my tail light and bumper

It is for that reason that I am executing this affidavit to file a claim for insurance.

I, therefore, have executed this Affidavit to attest the truth I mentioned herein and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _ day of __ 20____ in _, ___, Philippines.


Philippine Passport No.

valid until _________ , 20____

If you found this template for Vehicle Insurance Claim useful, you might also be interested in: Affidavit for Change of Color of Motor Vehicle