REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ALBAY ) S.S.

TABACO CITY )
x------------------------------------------x

AFFIDAVIT FOR CHANGE OF BODY OF MOTOR

VEHICLE

I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of

_______________________________, after having been duly sworn to in accordance with
law, depose and state THAT:

1. I am the registered owner of a motor vehicle which is particularly described as follows:

Make & Type : ________________

Motor Number : ______________

Chassis Number : ____________

Plate Number : _______________

MV File No. : _________________

Year Model :__________________

Color : _______________________

2. The original body type of the said motor vehicle was "_____________";

3. To have more use of the said vehicle in my business, I have decided to change the body
type of the said vehicle from "_____________" to "_____________";

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 ___________________ in Pasay

City, Metro Manila, Philippines.

__________________________

Affiant

SSS ID No. _____________

SUBCRIBED AND SWORN TO before me this ___________________ in _________________,

Philippines, affiant exhibiting to me his/her competent evidence of identity by way of
__________________ issued at ______________ on __________________.
 ATTY. ANTHONY CLARK A. GAPIDO
Notary Public Tabaco City
For the Province of Albay
Roll No. 83746
IBP OR No. 227570; June 13, 2022
PTR No. 8843533; July 13, 2022 at Tabaco City
MCLE: N/A (Newly Admitted to the Bar)
2nd Floor Coastal Building Rental, Purok 2,
Morales Street, San Roque,Tabaco City, 4511

Doc No.____;
Page No. 450;
Book No. 35 ;
Series of 2022