REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU ) S.S.

AFFIDAVIT
------------------

I, Name, of legal age, Filipino, single and with office address at ______ St.,
_______, ____ City, Philippines after having been duly sworn to in accordance with
law, hereby depose and state: That –

1. I am the Position of _________ Corporation (hereinafter referred to

as “__”), a corporation organized and existing under the laws of the
Philippines, with principal place of office at ____ ;

2. I was authorized and instructed by Corporation to transfer the engine

of a motor vehicle more particularly described as follows:

a. CR No/RRPL. _______________;
b. OR No. ______________;
c. Make: ________________;
d. Model: _______________;
e. Classification: Private Utility Vehicle/UV/GAS;
f. Plate No.: ________;
g. Chassis No.: __________;
h. MV File No. __________; and
i. Engine No.: _________.

3. The engine of the above-described vehicle was transferred to a Toyota

Tamaraw owned and maintained by ___________ (hereinafter
referred to as “___”), with principal place of office at _______, and
more particularly described as follows:

a. CR No./RRPL _______________;
b. OR No. _______;
c. Make: __________;
d. Model: ;
e. Classification: Private Utility Vehicle/DIESEL;
f. Plate No.: ______;
g. Chassis No.: ______;
h. MV File No.: ______;
i. Motor No. ______.

4. I am executing this affidavit to establish and attest to the truthfulness

of the foregoing facts and for all other legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my signature this ___ 2017 in

City, Philippines.

____________________________
Name:
Affiant

SUBSCRIBED AND SWORN to before me this ___day of ____ 2017 in ____

City, the affiant personally appearing before me and personally identified to me by
his competent evidence of identification as follows: _______ ID No.
____________________.

Doc. No. ___;