REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LA UNION ) Sc.

MUNICIPALITY OF TUBAO )
x-------------------------x

AFFIDAVIT OF MECHANICS

I, IMEE V. LAROCO, owner of ADNOR’s AUTO REPAIR shop located at

FRANCIA SUR, TUBAO, LA UNION. That the motorcycle with Chassis No.
_______________________Engine No.______________________has brought to my shop for
assembly as a tricycle unit; thereof it takes into consideration the safety of all passengers.

I personally attached/supervised the attachment of the sidecar into the above-described

motorcycle.

I personally assume all liabilities in case of any findings of negligence in the actual attachment of
the sidecar to the motorcycle.

I assure the roadworthiness and safety of the assembled tricycle.

IN WITNESS WHEREOF, I have hereunto set my signature this 6th day of June 2014 at Tubao,
La Union.

_____________________________
Mechanics’s signature over printed name

SUBSCRIBED AND SWORN to before me this 6th day of June 2014 at Tubao, La Union by the
affiant appearing personally and who is known to me to be the same person who executed this affidavit.

ATTY. JOONEE RANDYL E. RIVERA

Notary Public
Doc. No.: 139; until December 31, 2014
Page No.: 28; Aspiras Highway, Francia Sur, Tubao, La Union
Book No.: III; Roll No. 61766, TIN 929-347-628
Series of 2014. PTR No. 8538617; 01-02-14, Tubao, LU
IBP Lifetime OR No. 933274; 01-02-14, SFLU