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Affidavit of Accident Sample and Complete Guide | Free Template

Affidavit of Accident: Meaning, Purpose, and Sample Form

An Affidavit of Accident is a sworn legal document executed by a person involved in or witness to an accident. It narrates the facts and circumstances surrounding the incident, including how, when, and where the accident occurred. This affidavit is commonly required for insurance claims, police or barangay reports, court cases, and official documentation.

This affidavit must be truthful and based on personal knowledge. Any false statement may result in legal consequences.

When Is an Affidavit of Accident Required?

An Affidavit of Accident is commonly required for the following purposes:

  • Vehicular or traffic accident reports
  • Insurance and damage claims
  • Police blotter or barangay reports
  • Workplace or public incident documentation
  • Court or legal proceedings

Supporting documents such as photos, police reports, medical records, or repair estimates may be attached when required.

What Should Be Included in an Affidavit of Accident?

A complete Affidavit of Accident should include:

  • Complete details of the affiant
  • Date, time, and place of the accident
  • Persons involved and vehicles or properties affected
  • Detailed narration of how the accident occurred
  • Extent of injuries or damages
  • Affiant’s signature and notarization

Sample Affidavit of Accident (Editable Template)

Replace all bracketed information below with the correct details before printing and notarization.

REPUBLIC OF THE PHILIPPINES
[CITY / MUNICIPALITY]
[PROVINCE]

AFFIDAVIT OF ACCIDENT

I, [FULL NAME OF AFFIANT], of legal age, [citizenship], [civil status], and residing at [complete address], after having been duly sworn in accordance with law, hereby depose and state:

1. That on [date], at approximately [time], at [exact location], an accident occurred involving:

[State names of persons involved, vehicles, plate numbers, or properties affected.]

2. That the accident happened under the following circumstances:

[Narrate clearly and chronologically how the accident occurred.]

3. That as a result of the accident, the following injuries or damages were sustained:

[Describe injuries, damages, or losses.]

4. That the incident was reported to [police / barangay / authority] on [date], if applicable.

5. That I am executing this affidavit to attest to the truthfulness of the foregoing facts and for whatever legal purpose it may serve.

6. That the foregoing statements are true and correct to the best of my knowledge and belief.

IN WITNESS WHEREOF, I have hereunto affixed my signature this [day] day of [month, year] at [place of execution].



_________________________________
[FULL NAME OF AFFIANT]
Affiant

SUBSCRIBED AND SWORN to before me this [day] day of [month, year] at [place], the affiant presenting competent proof of identity.


_________________________________
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.

Disclaimer: This template is for general reference only. For serious accidents, seek proper legal or medical assistance.

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