REPUBLIC OF THE PHILIPPINES }

CITY OF ILOILO } S.S.

AFFIDAVIT OF CHANGE COLOR

I, Charles Brent Matta, Filipino, of legal age, single, with

home address at Block 7 Lot 5 Orchard B Savannah Subd. Oton,
Iloilo, after having been duly sworn to in accordance with law,
hereby depose and state:

1. That I am the registered owner of a motor vehicle which

is particularly described as follows:
Engine Number: L15Z11402726
Chassis Number: PADGM6630EV001554
Plate Number: ABA 2973
MV File No.:0620-00000206166
Year Model:2014
Color: Golden Brown

2. That original color of the said motor vehicle was "Golden

Brown";

3. That due to aesthetic reason, I had its color repainted to

"Black" such that the color of the said motor vehicle was changed
from "Golden Brown" to “Black";

4. That said change of color is not intended for any illegal or

unlawful purpose but solely due to the foregoing reason;
5. That I am executing this Affidavit to attest to the truth of
the foregoing and in support of the application for the change of
color of the above-described motor vehicle on its Certificate of
Registration.
IN WITNESS WHEREOF, I have hereunto set my hand
this __________________ in Iloilo City, Philippines.

______________________
Charles Brent Matta
Affiant

SUBCRIBED AND SWORN TO before me this ______________

in Iloilo City, Philippines, affiant exhibiting to me his competent
evidence of identity by way of ID No. ____ issued on _______ by
____________________________________________________

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018