REPUBLIC OF THE PHILIPPINES)

LA TRINIDAD, BENGUET..)s.s

AFFIDAVIT OF CHANGE BODY

I, ___________________, of legal age, married, Filipino Citizen and with

residence and postal address at ______________, after having been duly sworn to in
accordance with law, do hereby depose and say that:

1. I am a ___________ by occupation and with business address at

___________________.

2. I was engaged to do body repair of the following motor vehicle, to wit:

a. Make:
Series:
Type:
Plate No.:
Motor No.:
Chassis No.:

3. I changed the body of the above-mentioned motor vehicle from its original
DROP SIDE to DROP SIDE WITH DETACHABLE PIPE RAILINGS AND CANOPY;

4. The changes mentioned above were not aimed to conceal a crime or

violation of the Land Transportation Code, Traffic Laws and Regulations or the
Revised Penal Code of the Philippines, but was principally for personal reason
or satisfaction;

5. I am executing this affidavit to attest to the truth of the foregoing and for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________________at La Trinidad, Benguet, Philippines.

Affiant
Driver’s License No. __________
Valid until _________

SUBSCRIBED AND SWORN TO BEFORE ME this ______________________ at La

Trinidad, Benguet. Affiant exhibited to me his Driver’s License bearing the above
information as competent proof of his identity.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2023.