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Waiver and Non Interest

This affidavit details a car accident that occurred between the affiant and another driver. The affiant was driving their Suzuki multicab when they were bumped by a Nissan while making a left turn. This caused the affiant bodily injuries. The driver and owner of the Nissan have agreed to share the cost of the affiant's medical bills for treating the injuries. As a result, the affiant waives any interest in filing civil or criminal charges against the driver and owner. The affiant signs the affidavit to attest to these details.

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Jade Granada
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154 views

Waiver and Non Interest

This affidavit details a car accident that occurred between the affiant and another driver. The affiant was driving their Suzuki multicab when they were bumped by a Nissan while making a left turn. This caused the affiant bodily injuries. The driver and owner of the Nissan have agreed to share the cost of the affiant's medical bills for treating the injuries. As a result, the affiant waives any interest in filing civil or criminal charges against the driver and owner. The affiant signs the affidavit to attest to these details.

Uploaded by

Jade Granada
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 )

CITY AND PROVINCE OF ILOILO ) S.S.


x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF WAIVER AND NON-INTEREST

I, ___________________, of legal age, married, Filipino, and a resident of


Brgy. _________________________, Philippines after having been duly sworn to in
accordance with law do hereby depose and say that:

1. Sometime on _______________ at around ___________ o’ clock in the afternoon


while I was driving my Suzuki Carry Pick-up Multicab with MV no.
______________________and was executing a left turn crossing at the
National Road, Brgy. __________________, I was accidentally bumped by a
Nissan _____________ with plate number ______________;

2. As a result thereof, I sustained several bodily injuries;

3. The driver of the above-mentioned motor vehicle in the person of


______________ and the registered owner, ___________________, will share on
the payment of the hospital bills needed for the treatment of my injuries;

4. In view thereof, I am no longer interested to file any civil or criminal cases


against the driver ______________________ and the registered owner,
__________________.

As such, I am executing this Affidavit in order to attest to the truthfulness of the


foregoing facts and for other legal purpose(s) this may serve best.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREFORE, in order to attest to the truth of the


foregoing, I am hereby affixing my signature to this Affidavit of Undertaking this
11th day of November, 2020 in ___________, Philippines.

Affiant
________________ID No. ______________________

SUBSCRIBED AND SWORN to before me this day 11th day of November,


2020, at the _____________________, Iloilo, Philippines. Affiant is personally
known to me to be the same person who executed the foregoing affidavit.

Doc. No. _____;


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

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