REPUBLIC OF THE PHILIPPINES}

MUNICIPALITY OF PATEROS } S.S.

METRO MANILA }

AFFIDAVIT OF CHANGE OF ENGINE

I, ______________________________________, single/married, of legal

age, Filipino and resident of ____________________________________________
_____________________________________________, under oath depose and
say that –

1. I am the lawful/registered owner of a certain vehicle described as

follows:

MAKE: ________________ ENGINE NO.: _____________________

TYPE: ________________ CHASSIS NO.: _____________________
MODEL: ________________ PLATE NO.: ______________________

2. That I bought one (1) new/used Engine from

____________________________ with Engine No. __________________.

3. The I changed the Engine of the aforesaid vehicle from Engine No.
_____________________ to Engine No. __________________.

4. That the change of Motor/Engine of the above described motor

vehicle was done in good faith to upgrade the running condition of
said vehicle and not intended to violate any law nor hide the
commission of any crime or irregularities.

5. I am executing this affidavit to attest the truth of the foregoing and

for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I affixed my signature this

____________________ at Pateros, Metro Manila.

______________________________
Affiant
ID No. _______________________

SUBSCRIBED AND SWORN to before me this ____________________

at Pateros, Metro Manila with Affiant affixing his signature in my
presence and within my notarial jurisdiction.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2020