Republic of the Philippines )

Province of Isabela )
Municipality of Tumauini ) S.S.

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AFFIDAVIT FOR CHANGE OF BODY

OF MOTOR VEHICLE

I, JHONA SALAZAR PACIFICO, of legal age, Filipino, (single/married/widow)

and a resident of Purok 3, Santa, Tumaini, Isabela, 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 : Mitsukoshi

Engine Number : 161MJJ1589992
Chassis Number : LF3PCK501JB826079
Plate Number : 779BFN
MV File No. : 0201-000007686079
Year Model : 2018
Color : Black

2. The original body type of the said motor vehicle was “Motorcycle without side car”;

3. To have more use of the said vehicle in my business, I have decided to change the
body type of the said vehicle from “Motorcycle without side car” to “Motorcycle with
side car”;

4. The change of body type 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 body type of the above-described motor vehicle on
its Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of November
2023, in the Municipality of Tumauini, Province of Isabela, Philippines.

JHONA SALAZAR
PACIFICO
(Signature of affiant)

SUBSCRIBED AND SWORN TO before me this 15th day of November 2023 in

Tumauini, Isabela, affiant exhibiting to me his ID No. ____________ issued at
________________.
Doc. No. ____
Page No. ____
Book No. ____
Series of 2023.