REPUBLIC OF THE PHILIPPINES)

Province of Sorsogon S.S.

City/Municipality of Sorsogon
x-----------------------x

A F F I D A V I T FOR CHANGE COLOR OF MOTOR VEHICLE

I, LIAO KA PEN, Filipino, of legal age, married, and a resident of 4705 Barangay
Polvorista, East District, Sorsogon City, Philippines, after being sworn to in accordance with
law, depose and state:

1 That I am the registered owner of a certain motor vehicle that is more particularly
described as follows:

Make: TOYOTA Motor No.: 4K-5472456-NEW

Type: OWNER JEEP Chassis No.: GJC-752125
Color: GOLD/SILVER Plate No.: EAM345

2 That the original color of the said motor vehicle was "GOLD/SILVER";

3 That when the paint of the above-described motor vehicle had faded, I had its color
repainted to SALVACION L. LAGARDE such that the color of the said motor
vehicle was changed from "GOLD/SILVER" to “YELLOW/SILVER";

4 That said change of color is not intended for any illegal or unlawful purpose but
solely due to the foregoing reasons;

5 That I am executing this Affidavit to attest to the truth of the foregoing and in support
of the application for the change of color of the above-described motor vehicle on its
Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ in

_____________, Philippines.

LIAO KA PEN
Affiant

SUBSCRIBED and SWORN to, BEFORE ME, this _____ day of __________, 2018.
Affiant personally appeared and has satisfactorily established his identity to me by exhibiting his
_________________ issued on _______________ issued at _________________ who is the
same person who personally signed before me the foregoing affidavit and acknowledged that he
executed the same.

NOTARY PUBLIC
Doc. No. ____
Page No. ___
Book No. ____
Series of 2018