REPUBLIC OF THE PHILIPPINES)

CITY OF ROXAS………………………) S.S.

X…………………………………………….X

JOINT AFFIDAVIT OF CHANGE BODY DESIGN

That I, MENDALINA C. BERMEJO Filipino, married/single and a resident of BRGY.

TANZA GUA, ROXAS CITY and respectively, after having duly sworn to an oath do
hereby depose and say;

That I, MENDALINA C. BERMEJO the absolute registered owner of a motor vehicle

more particular described as follows:

MAKE &TYPE: KAWASAKI

ENGINE NO: BC175AELE5995

CHASSIS NO: BC175J-B11506

Since our unit now with sidecar, that I caused the installation;

That for this undertaking, I hired the services of ________________an auto

mechanic to do the job.

That I,______________ was hired by RUBEN P. RAMOS the body design of the said
motor vehicle;

That WE execute this joint affidavit to attest to the truth of the said foregoing facts.

IN WITNESS WEREOF, or have hereunto set our hands this ________ day of
_________, ______, in the City of Roxas, Philippines.

MENDALINA C. BERMEJO _____________________________

Affiant/Owner Affiant/Mechanic
ID# ID#

SUBSCRIBED AND SWORN to before me this _________ day of _________, ______, in the
City of Roxas, Philippines.