REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ISABELA )S.S.

MUNICIPALITY OF ROXAS )
x---------------------------------------x

AFFIDAVIT OF CHANGE BODY DESIGN

I, NOLAN LIWAG, of legal age, Filipino citizen, and a resident of Sandiat East, San
Manuel, Isabela after having been duly sworn to in accordance with law, do hereby depose and
say:

1. That I am the registered owner of a certain motor Vehicle more particularly described
as follows:

CHASSIS NO. ------------ KPY00027087

ENGINE NO. ------------ KPY00E027031
MV. FILE NO. ------------ 0201-00000024184
PLATE NO. - - - - -- - - - - -- - BA 51735
MAKE. ------------ HONDA

2. That, I have caused the change of the body design of the said vehicle from MC to
MTC;

3. That I am executing this affidavit in good faith, attesting to the truth of all the
foregoing statements made above, informing the authorities concern of the changed of the
BODY DESIGN of my above-described motorcycle, for proper recording and for all
legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of April 2022 at
Roxas, Isabela.

NOLAN LIWAG
Affiant

SUBSCRIBED AND SWORN to before me this 26th day of April 2022 at Roxas, Isabela.

DAVID S. SALIBAD JR.

Notary Public
Doc. No.:141 Until December 31, 2023
Page No.:30 Roll No. 55179
Book No: 15 IBP Lifetime member NO.018401
Series of 2022 PTR No. 14516901, Isabela,1-03-2022
MCLE Compliance No. VI-0018493
N.C. No. 23-08-08, Dec. 2, 2019
Vira, Roxas, Isabela