REPUBLIC OF THE PHILIPPINES )

La Trinidad, Benguet…………) s.s.

AFFIDAVIT
(RE: Change Body Design of a Motor Vehicle)

I, ____________________________________, of legal age, married, Filipino

Citizen and a resident of _______________________________, Philippines, under oath declare
and state that:

1. I am an a diesel mechanic by profession with auto shop at

______________________;

2. I changed and/or modified the body design of the motor vehicle which is more
particularly described as follows:

Make/Series: REBUILT Body Type: MINI DUMP

TRUCK

Model: 2017 Plate No.

Chassis No. Engine No.

Denomination: MV File No.

3. I changed and/or modified the body design of the above described motor vehicle
from “MINI DUMP TRUCK” to “MINI DUMP TRUCK with
DETACHABLE PIPE RAILINGS and CANOPY”. Thus, the body design is
now ““MINI DUMP TRUCK with DETACHABLE PIPE RAILINGS and
CANOPY”;

4. I am executing this affidavit to support the request for the issuance of a new
Certificate of Registration with the correction of the body design from “MINI
DUMP TRUCK” to “MINI DUMP TRUCK with DETACHABLE PIPE
RAILINGS and CANOPY”

5. 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 ___ day of

___________________ in __________________________________, Philippines.

______________
Affiant

SUBSCIBED AND SWORN TO before me this ____ day of

_______________________ in ___________________________, Philippines.