Republic of the Philippines )

Province of IlocosNorte )
City of Batac )S.S.

AFFIDAVIT OF CHANGE
(Motor Vehicle)

I, VALERIANO PANGILINAN y SABADO, of legal age, married,

Filipino citizen, and a resident of Brgy. Maglaoi Centro,
Batac City, IlocosNorte, Philippines, after having been duly
sworn to in accordance with law, do hereby depose and say
that:
1. I am the registered owner of a motor vehicle which is
particularly described as follows:
Make & Type : Honda Motorcycle Motor Number :
KYA01E040582
Chassis Number : KYA01040516 Plate Number :
MV File No. :0101-00000364457 Year Model
: 2016
Color : Black Denomination :
Motorcycle w/o sidecar
CR No. : 273592933

2. The original denomination of the said motor vehicle was

MOTORCYCLE WITHOUT SIDE CAR however due to the necessity
of a private service for my family, I had to modify the
said motorcycle attaching therewith a side car made of
aluminum;

4. Said change is not intended for any illegal or unlawful

purpose but solely due to the foregoing reason;

5. I am executing this Affidavit to attest to the truth of

the foregoing and in support of the application for the
renewal of the Certificate of Registration and for the
change of denomination of the above-described motor
vehicle on its Certificate of Registration.

IN WITNESS WHEREOF, the affiant hereunto set his hand

this __________________ in Batac City, IlocosNorte,
Philippines.

VALERIANO S. PANGILINAN
Affiant

SUBSCRIBED AND SWORN to before me this __________________ at

Batac City, Philippines; affiant exhibiting to me his LTO
Driver’s License with No. A04-10-001918 and I am satisfied
that he voluntarily executed the same and understood the
contents thereof.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2018