REPUBLIC OF THE PHILIPPINES)

CITY OF DUMAGUETE ) S.S.

AFFIDAVIT FOR CHANGE OF BODY OF

MOTOR VEHICLE

I, ALFREDO RENDORA, Filipino, of legal age, married, and a resident of Siapo, San
Jose Negros Oriental, after having been duly sworn to in accordance with law, do hereby depose
and state THAT:

1. I am the new owner of a motor vehicle which is currently registered under the name of
William Lee Matteson and more particularly described as follows:

 Make and Type : Suzuki, Pick-Up

 Chassis Number : DK51T-105184
 Engine Number : F6A-5763030
 Plate Number : GNZ192
 MV File Number : 071600000226305
 Year Model : 2002
 Color : White

2. The original body type of the abovementioned motor vehicle is “Pick-Up”;

3. In order to make use of the back part of the motor vehicle for carriage of goods, I have
decided to change its body type from “pick-up” to “pick-up with canopy”;

4. The change of body type is not intended for any illegal or fraudulent purpose but solely
due to the foregoing reason;

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

IN WITNESS WHEREOF, I have hereunto affixed my signature this 19th day of

February, 2021, in Dumaguete City.

ALFREDO RENDORA
Affiant
Identification Card:
I.D. No.:

Subscribed and sworn to before me, this 19th day of February, 2021, Dumaguete City,
Philippines, Affiant personally appeared and exhibited to me her proof of identity.

Doc. No._____
Page No.____
Book No. ____
Series 2021.