REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BENGUET ) SS.

CITY OF BAGUIO )

AFFIDAVIT OF CHANGE COLOR

I, ROUEL DE OCAMPO, of legal age, married, Filipino and with residence at

102 Lower Cabinet Hill, Teacher’s Camp, Baguio City, Philippines, under oath, depose and say
that:

I am an owner of a Motor Vehicle which is particularly described as follows:

MAKE ANFRA
TYPE TRANSPORTER/ANALOK
MOTOR NO F6408503
SERIAL/CHASSIS NO F3B-9503804-C
PLATE NO UV-UDR759
MV FILE NO 1348-12548
CR NO 1303903834

I want to add color to the said vehicle which is YELLOW to a repair shop;

That I am executing this affidavit attest to the truth of my foregoing statements

and to comply with the rules and regulations of the Land Transportation Office anent the change
of COLOR of a motor vehicle into WHITE-YELLOW COLOR.

IN WITNESS WHEREOF, I have hereunto affixed my name and signature this

9 day of October, 2019, at Baguio City, Philippines.
th

ROUEL DE OCAMPO
Affiant
BIR TIN No.: 105-451-211

SUBSCRIBED AND SWORN TO BEFORE ME, this 9th day of October, 2019,
at Baguio City, Philippines. Affiant personally appeared before me and who represented himself
to me to be the same person who executed this instrument.

MODESTO T. ANDONG
Notary Public
Commission No. 39-NC-18-R/Until: Dec. 31, 2019
PTR No. 3954050/1-3-2019/Baguio City
IBP No. 02793/1-3-2019
Roll No. 31289/5-15-81/Manila
Doc. No. 17; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 04; BIR TIN No. 121-017-652
Book No. 39; No. 19, 2nd Floor Old Market Bldg.,
Series of 2019. Magsaysay Ave., Baguio City, Philippines