REPUBLIC OF THE PHILIPPINES

CALOOCAN CITY

AFFIDAVIT OF CHANGE ENGINE

ARMIDA P. PASCUAL of legal age, Filipino, single and a resident of 1420 M.Naval St.,
Tangos, Navotas City, is the lawful owner of a certain motor vehicle which is more particularly
as follows;

1. That I am the legal owner and possessor of a motor vehicle particularly described as:

Make & Type . . . . . . . . . . . . . . . . . . . . . . . Toyota

Serial/Chassis No. . . . . . . . . . . . . . . . . . . . EXL-2002090186-C
Engine No. . . . . . . . . . . . . . . . . . . . . . . . . 2T-2453483
Fuel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gas
Type of Body . . . . . . . . . . . . . . . . . . . . .. . . Jeep
Year Model . . . . . . . . . . . . . . . . . . . . . . . . . 2002
File No. .. . . . . . . . . . . . . . . . . . . . . . . . . . . 1332-00000100663
Plate No. . . . . . . . . . . . . . . . . . . . . . . . . . . . XFE141
CR No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253037271

2. That I caused the change of the engine of the above-described motor vehicle from
Engine No. RF-436181 to 2T-2453483.

3. That ____________________ of _____________AUTO SHOP was the one who

changed the ENGINE of the above-described motor vehicle.

4. That I execute the affidavit to attest to the truth of the above facts, and circumstances
and for whatever legal purposes it may serve.

IN WITNESS WHEREOF I have hereunto set my hand this _____ day of _____, 2019,
in Caloocan City.

______________________
Affiant

SUBSCRIBED AND SWORN to before me, this _____ day of ____, in Caloocan City.
Affiant exhibiting to me their above mentioned government issued I.D.’s as their competent
evidence of identity bearing their photographs and signatures.

Doc. No._____
Page No. _____ NOTARY PUBLIC
Book No. ____
Series of _____