REPUBLIC OF THE PHILIPPINES )

City of _________________ ) S.S.

x------------------------------------- /

AFFIDAVIT OF CHANGE OF COLOR

(of Motor Vehicle)

I, MA. MARLIE O. REPUNTE, of legal age, Filipino, married and a resident of Pit-os 1,
Cebu City, after having been duly sworn according to law do hereby depose and state: That –

1. I am the registered owner of a motor vehicle, which is more particularly described

as follows:

Make: YAMAHA Motor No.: 40C051452

Series: MIO SPORTY 40C5 Chassis No.: PA040C000B0093017
Body Type: MC Plate Number: 4614 IQ
Year Model: 2011 MV File No.: 0760-00000210841

2. The original color of the said motor vehicle was “white”.

3. However, when the paint of the above-described motor vehicle had faded, I had its
color repainted to “yellow,” such that the color of the said motor vehicle was
changed from “white” to “yellow”.

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

5. I am executing this affidavit to attest to the truth of the foregoing facts 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 affixed my signature below this

__________________ at Cebu City, Philippines.

MA. MARLIE O. REPUNTE

Affiant
CAAP ID No. 113628-AMT; Expires on 30 November 2020

SUBSCRIBED AND SWORN to before me this ________________ at Cebu City,

Philippines, affiant having exhibited to me her competent proof of identity indicated below her
name and avowed to me as to the truthfulness of the contents of herein document which she
voluntarily signed in my presence.
 WITNESS MY HAND AND SEAL, on the date and at the place above-written.

Doc. No.
Page No.
Book No.
Series of 2019.