REPUBLIC OF THE PHILIPPINES)

CITY OF Cabanatuan ) S.S.

x------------------------------------x

AFFIDAVIT OF CHANGE COLOR

I, Cristopher F. Dela Cruz, of legal age, Filipino, (single/married/widow) and a resident of P-2 Sumacab
South, Cabanatuan City, after having been duly sworn to in accordance with law, depose and state
THAT:
1. I am the registered owner of a motor vehicle which is particularly described as follows:

Make & Type : Yamaha

Motor Number : G3E4E-1943295
Chassis Number : MH3SG3160K0120579
Plate Number :038402
MV File No. :0384-00000083543
Year Model :2020
Color : Matte Gray / Silver

2. The original color of the said motor vehicle was " Matte Gray / Silver ";
3. When the paint of the above-described motor vehicle had faded, I had its color repainted to "Pearl
White" such that the color of the said motor vehicle was changed from "Matte Gray" to "Pearl White";
4. Said change of color is not intended for any illegal or unlawful purpose but solely due to the foregoing
reasons;
5. I am executing this Affidavit to attest to the truth of the foregoing and in support of the application for
the change of color of the above-described motor vehicle on its Certificate of Registration.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in Cabanatuan City ,
Nueva Ecija , Philippines.

Christopher F. Dela Cruz

Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines,

affiant exhibiting to me his/her competent evidence of identity by way of __________________ issued
at ______________ on __________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.