REPUBLIC OF KENYA

AFFIDAVIT
I, HHHHHHHHH of Post Office Box Number errereer, xxxxxxx in the Republic of Kenya DO MAKE OATH as
follows:-

THAT I am the registered legal owner of a motor vehicle (the “Vehicle”) the particulars whereof are as
follows:

REGISTRATION NUMBER - DDDDDDD

MAKE - DDDDDDDD
TYPE OF BODY - GGGGGGG
CHASSIS - JJJJJJJJJJ
ENGINE NUMBER - KKKKKKKK
YEAR OF MANUFACTURE - LLLLLL
RATING (c.c.) - KKK c.c.

THAT the colour of the body of the Vehicle was until 19uu blue and that the same is indicated in the
Registration Book for the Vehicle.

THAT sometime in 19vv the colour of the body of the Vehicle was changed from blue to white by yyyyyy
Limited of Post Office Box Number jjjj ,mmmmmm who were my employers at that time.

THAT for all purposes the colour blue as entered in the Registration Book of the Vehicle should now read
and deemed to be white.

THAT I swear this Affidavit in support of my application to have the correct colour of the Vehicle, being white
and not blue, recorded in the Registrar of Motor Vehicles’ records and the Vehicle’s Registration Book.

THAT what is stated hereinabove is true and correct to the best of my knowledge, information and belief
except as otherwise stated.

SWORN to by the said hhhhhhhhh )

at on this day of )
2003. )
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BEFORE ME )
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COMMISSIONER FOR OATHS )