Republic of the Philippines ) S.

S
City of ____________________ )
x--------------------------------------------- x

AFFIDAVIT OF OWNER/MECHANIC

I, RONNIE LAGAYAN WACLIN of legal age, married, Filipino citizen, with residence
and postal address at Pinsao Pilot, Baguio City, under oath hereby depose and state that;

1. I am the owner of a certain motor vehicle thru deed of sale more particularly described as
follows:
Make: Mitsubishi/Aluminum Van
Serial No.: FE515B-A02188
Engine No.: 4D33-D55819
Color: White
Plate No.: UTH 530

2. I am a mechanic by profession and I changed the BODY DESIGN of the said motor
vehicle at my residence from ALUMINUM VAN to ALUMINUM SIDE W/
DETACHABLE PIPE RAILINGS AND CANOPY;

3. I am executing this affidavit as a requirement for the registration of above-mentioned

motor vehicle before the Land Transportation Office and to attest to the truth and for all
legal intents and purposes it may best serve.

RONNIE LAGAYAN WACLIN

Affiant

SUBSCRIBED AND SWORN to before me this _________ day of _____________2020

at ______________________, Philippines.

Doc No. __________;

Page No. __________;
Book No. _________;
Series of 2020;