Republic of the Philippines)

Province of Cagayan ) S.S.

Tuguegarao City )
x--------------------------------------x

AFFIDAVIT

I, GARY T. NATIVIDAD, of legal age, single and a resident of 1008 Cruz Village Caggay
Tuguegarao City, under oath, do hereby depose and say:

1. That I am the true owner of a certain TOYOTA VIOS motor vehicle with plate no.
ZEX717;

2. That the original color of said motor vehicle is RAVE BLUE as registered at the
Land Transportation Office (Tuguegarao District Office) and hereto indicated at the
ORIGINAL RECEIPT dated 06/20/2016 issued by the same office ;

3. That sometime on October 2016, I had the said motor vehicle repainted with the color
BLUE;

4. I am executing this affidavit to attest the truth of the foregoing for the registration of
the change in color of the aforementioned vehicle at the Land Transportation Office
and for whatever legal purpose it may serve;

AFFIANT FURTHER SAYS NAUGHT.

IN WITNESS WHEREOF, we have hereunto set our hands, this ________________at

Tuguegarao City, Cagayan.

GARY T. NATIVIDAD
(Affiant)

SUBSCRIBED AND SWORN TO BEFORE ME this

_______________________________________________, affiant exhibited to me his ID with No.
______________ issued at __________________________on
___________________________________.

NOTARY PUBLIC

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2016.