REPUBLIC OF THE PHILIPPINES)

) S.S.
X-------------------------------------X

AFFIDAVIT OF DETACHMENT

I _____________ resident of _____________ after having been duly sworn to in accordance

with law, do hereby depose and say;

That I am the true and registered owner of one motorcycle with sidecar which is more
particularly described as follows:

MAKE/TYPE :
MOTOR NO. :
CHASSIS NO. :
PLATE NO. :
MV FILE :

That I have decided to detach said sidecar from my motorcycle for the purpose of converting
it to a single motorcycle;

That I am the as well as the mechanic who detached the said side car to make it into
motorcycle type motor vehicle; that I hired Mr. _______ of___________.

That said motorcyle is not ready for registration with LTO ___________Office.

That I am executing this affidavit to attest to the truth of the above stated facts in connection
with the detachment of a sidecar.

IN WITNESS WHEREOF, I hereunto affixed my signature _____________, at _______,

Philippines.

____________ ________________
Owner Mechanic

SUBSCRIBED AND SWORN to before me this ___________ at ________, Philippines, affiant

exhibiting to me her proof of identity: ___________________.

Doc. No.:___
Page No.:____
Book No.:____
Series of 202__.