Republic of the Philippines }

CITY OF SURIGAO } S.S.

AFFIDAVIT FOR CHANGE OF BODY

OF MOTOR VEHICLE
I, AUGUSTO T. ACLO. , of legal age, Filipino, married and a resident of Brgy.
Cagniog, Surigao City , Surigao del Norte, Philippines after having been duly sworn
to in accordance with law, depose and state THAT:

1. That I am the registered owner of a certain Motorcycle, which is more

particularly described as follows:
    
             Make & Type :  KAWASAKI
Body Type : MC
            Motor/Chassis Number :  MD2A76BY1KWC70638
          Plate Number :  150110
            Series Number : CT125A
   Year Model : 2019
C.R Number : 335826735
O.R Number : 1978258085
     
2. The original body type of the said motor vehicle was described as " MC Motor
Vehicle";

3. To have more use of the said vehicle, I have decided to change the body design of
the said vehicle from " MC Motor Vehicle" to " Tricycle type" which is to be done by
PEPE WELDING SHOP, work done by Epelino Aquino a mechanic who knows how to
weld as well, which such job was done in his shop at Purok Zenia, Nueva St. Brgy.
Taft, Surigao City, Surigao del Norte;

4. The change of body type 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 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 set my hand this 4th day of

May 2021 in Surigao City, Philippines.

AUGUSTO T. ACLO
Affiant

SUBSCRIBED AND SWORN, to before me this 4th day of May 2021 in the
City of Surigao, Philippines with affiant presenting his Driver’s License K07-19-
005450, bearing his photograph and signature as competent proof of his identity.

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Series of 2021.