Republic of the Philippines)

Province of Nueva Ecija )

City of Palayan )S.S.
x-----------------------------------------x
AFFIDAVIT

I, LUISITO V. BENITO, JR., of legal age, married, Filipino and a resident of

Pamaldan, Cabanatuan City, Nueva Ecija, after having been duly sworn to in
accordance with law, hereby depose and state:

1. That I am the owner of a utility vehicle which is hereto described as:

MV File No.: 1372-00000174058

Make: Honda
Denomination: Car Light
Color: Bronze
Series: Civic
Engine No.: PH16A0010292
Body Type: Sedan – 4-Door
Chassis No.: PHSO4-3A6415
Year Model: 1996
MV File No.: 0332-00000127430
Plate No.: UNA368
Certificate of Registration No.: 168949524
Official Receipt No.: 1690446612

2. That on November 15, I have had the aforesaid motor vehicle painted with
another color which is red;

3. That aforementioned change of color is done by a painter named Reynerio

“Jhun” B. Vibal, Jr. in his backyard in Marcos Village, Palayan City, Nueva
Ecija;

4. That this affidavit has been executed to attest to the truth of all the
foregoing facts and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

_______________, 2019, at __________________________.

LUISITO V. BENITO, JR.

Affiant

SUBSCRIBED AND SWORN to before me on the date and place above written.

________________________________
NOTARY PUBLIC

Doc. No. _____

Page No. _____
Book No. _____
Series of 2019.