Affidavit of Damage: Meaning, Purpose, and Sample Form
An Affidavit of Damage is a sworn legal document executed by a person whose property has been damaged due to an incident such as an accident, natural disaster, vandalism, or negligence. It formally states the facts and circumstances surrounding the damage and is commonly required for insurance claims, legal actions, barangay or police reports, and requests for repair or replacement.
This affidavit is executed under oath and must be truthful and accurate. Any false statement may result in legal liability.
When Is an Affidavit of Damage Required?
An Affidavit of Damage is commonly required for the following purposes:
- Insurance claims for damaged property
- Reporting accidents or incidents to authorities
- Filing claims for repair, reimbursement, or compensation
- Submission to barangay, police, or government agencies
- Supporting civil or administrative cases
Supporting evidence such as photos, repair estimates, receipts, or inspection reports may be attached when required.
What Should Be Included in an Affidavit of Damage?
A complete Affidavit of Damage should include:
- Complete details of the affiant
- Description of the damaged property
- Date, time, and place of the incident
- Cause and circumstances of the damage
- Extent or nature of the damage
- Affiant’s signature and notarization
Sample Affidavit of Damage (Editable Template)
Replace all bracketed information below with the correct details before printing and notarization.
REPUBLIC OF THE PHILIPPINES
[CITY / MUNICIPALITY]
[PROVINCE]
AFFIDAVIT OF DAMAGE
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 I am the lawful owner/user of the property described herein.
2. That on or about [date], at approximately [time], at [place], the following property was damaged:
[Describe the damaged property, including type, brand, model, location, and value if applicable.]
3. That the damage occurred under the following circumstances:
[Clearly narrate how the damage happened and identify the cause if known.]
4. That the nature and extent of the damage are as follows:
[Explain the specific damage, affected parts, and estimated impact.]
5. That I am executing this affidavit to formally report the damage and for whatever legal or official 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 damage claims, consult proper authorities or legal counsel.