REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LA UNION ) Sc.

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

AFFIDAVIT OF CHANGE OF BODY

KNOW ALL MEN BY THESE PRESENTS:

I, ALMARIO A. PANELO, of legal age, married, Filipino citizen and a resident of

Magsaysay, Tubao, La Union after having been duly sworn to in accordance with law, do hereby
depose and state, that:

1. I am the owner of the following vehicle, more particularly described as follows:

MAKE----------------Honda
TYPE ----------------Motorcycle
CHASSIS No. ------- KB503021019219
ENGINE/MOTOR No. KB503021019219E

2. That I have caused the change of the body of said Tricycle from its original
classification TRICYCLE FOR HIRE to PRIVATE;

3. The changes mentioned above were not aimed to conceal a crime or violation of the
Land Transportation Code, Traffic Laws and Regulations or the Revised Penal
Code of the Philippines, but was principally for personal reason and satisfaction;

4. I am executing this Affidavit to attest to the truthfulness and veracity of the

foregoing narration of facts; and for whatever legal intents and purposes this may
well serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of November,
2017 at Tubao, La Union, Philippines.

ALMARIO A. PANELO
Affiant

SUBSCRIBED AND SWORN to before me this 29th day of November, 2017 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 until December 31, 2018
Doc. No.:174 ; Aspiras Highway, Francia Sur, Tubao, La Union
Page No.: 35; Roll No. 61766, TIN 929-347-628
Book No.: XIV; PTR No. 1470534; 01-03-17, Tubao, LU
Series of 2017. IBP Life Member No. 012553; 01-02-14, SFLU
Commission No. ANC-2016-30