Free Affidavit of Accident Template
Affidavit of Accident
State of [STATE]
County of [COUNTY]
Introduction:
I, [YOUR NAME], of legal age, residing at [YOUR ADDRESS], City of [City], County of [County], State of [State], being duly sworn, do hereby affirm and declare under penalty of perjury as follows:
Statement of Facts:
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This affidavit is made to document the details and impact of a vehicle accident I was involved in (or witnessed) on [Date of Accident] at approximately [Time of Accident] at the location of [Exact Location of Accident], in the city of [City], county of [County], state of [State].
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The accident involved a car colliding with a pedestrian at a crosswalk, resulting in injuries to the pedestrian. Emergency services were immediately called to the scene to provide medical assistance and assess the extent of the injuries.
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The vehicles involved in the accident were a black Toyota Corolla sedan and a blue Honda Civic hatchback. The license plate numbers are unknown at this time, but both vehicles sustained visible damage to their front ends as a result of the collision.
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Driver of the black Toyota Corolla:
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Name: [NAME]
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Contact: [Phone Number]
Pedestrian:
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Name: [NAME]
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Contact: [Phone Number]
Witnesses (if any):
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Name: [NAME]
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Contact: [Phone Number]
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The accident occurred on a clear day with good visibility at an intersection with a marked crosswalk. The pedestrian, was crossing the street within the crosswalk when the black Toyota Corolla, failed to yield and struck them
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Both vehicles were traveling eastbound, and there were no relevant traffic signs or signals at the intersection. Emergency services were immediately contacted, and bystanders provided assistance until medical help arrived.
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The immediate impact of the accident resulted in sustaining injuries to her lower extremities, requiring immediate medical attention.
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Both vehicles involved suffered significant damage to their front ends, and emergency services, including ambulance and law enforcement, were promptly called to the scene to provide assistance and assess the situation.
Supporting Documentation:
Attached hereto are [list any supporting documents, such as photographs of the accident scene, medical reports, police reports, or witness statements, if available].
Statement of Truth:
I hereby affirm that the information provided in this affidavit is true and accurate to the best of my knowledge and belief. I understand that this affidavit is made for the purpose of documenting the aforementioned accident and may be used in legal proceedings, insurance claims, or other related matters.
Executed on this [DAY] of [MONTH], [YEAR].
Signature:
[YOUR NAME]
Subscribed and sworn to before me this [DAY] of [MONTH], [YEAR], by [YOUR NAME], known to me or proved to me on the basis of satisfactory evidence to be the person who appeared before me.
[Notary Public's Signature]
