REPUBLIC OF THE PHILIPPINES)

______________________ ) SS.

A F F I D A V I T for Change of Body of Motor Vehicle

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

_____________, Philippines, after being sworn to in accordance with law, depose and state:

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

Make: ____________________________
Motor No.: ________________________
Type: ____________________________
Chassis No.: _______________________
Series: ____________________________
Plate No.: _________________________

2. That the original body type of the said motor vehicle was “____________”;

3. That to have more use of the said vehicle in my business, I have decided to change the body
type of the said vehicle from (describe what you will change on your motor vehicle)
“______________________” to “______________________”;

4. That the change of body type is not intended for any illegal or unlawful purpose but solely due
to the foregoing reasons;

5. That I am executing this 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 _____________,

Philippines.

__________________________
AFFIANT
SUBSCRIBED AND SWORN to before me this ____th day of _____________, in
______________, affiant personally exhibiting his/her valid I.D as proof of his/her identity
bearing his picture and signature.

Doc. No. _______ NOTARY PUBLIC

Page No. ______
Book No. _______
Series of 20______