REPUBLIC OF THE PHILIPPINES}

MUNICIPALITY OF PATEROS } S.S.

METRO MANILA }

AFFIDAVIT OF CHANGE OF BODY

I, MARIO C. VILLADIEGO, of legal age, Filipino and resident of
Block 4, Lot 5, M. Lozada Street, Pateros, Metro Manila, under oath
depose and say that –

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

follows:

ENGINE No. : ______________________

CHASIS No. : ______________________
PLATE No. : ______________________

2. That the original body type of the said motor vehicle was
motorcycle without sidecar.

3. That I changed the body/type of the said vehicle from MC to TC or

with sidecar.

4. That the change of body/type is not intended for any illegal or

unlawful purpose.

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 ___ day of

____________________________ at Pateros, Metro Manila.

MARIO C. VILLADIEGO
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of

_________________ 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 2021