REPUBLIC OF THE PHILIPPINES )

LA TRINIDAD, BENGUET…………) s.s.

AFFIDAVIT
(RE: Change Color of a Motor Vehicle)
I, Affiant, of legal age, single/married, Filipino Citizen, and resident of Cotcot, Bangao,
Buguias, Benguet, Philippines, under oath declare and state that:

1. I am the registered owner of that motor vehicle more particularly described as

follows:

Make/Series:
Engine No.:
Chassis No.:
Model:
Plate No.:

2. I changed the color of the above-described motor vehicle from BLUE to

BLUE/SILVER;

3. I am executing this affidavit to support my request for the issuance of a new

Certificate of Registration of the above-described motor vehicle with the correction
of the color thereof from BLUE to BLUE/SILVER, with the Land Transportation
Office;

4. Finally, I am executing this affidavit to attest to the veracity of all the foregoing
statements and for all legal intents and purposes it may well serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 7 th day of January

2020 in La Trinidad, Benguet, Philippines.

affiant
Affiant

SUBSCIBED AND SWORN TO before me this 7th day of January 2020 in La Trinidad,
Benguet, Philippines.

Doc. No.
Page No.
Book No.
Series of 2020.