REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) S.S.

CITY OF TANDAG)

AFFIDAVIT FOR CHANGE OF COLOR

OF MOTOR VEHICLE

YUL BERNIE L. CURADA, of legal age, Filipino, ,married, and a resident of Tago,
Surigao del Sur, after having been duly sworn in accordance with law, depose and state THAT:

1. I am the registered owner of a motor vehicle which is particularly described as follows:

CR No. : 323833160
OR No. : 1466621656
MV File No. : 0701-00000750080
Plate Number : GAI 9425
Engine Number : YD25776053T
Chassis Number : 1NTCC2D2370040936
Denomination : UTILITY VEHICLE
Year Model : 2018
Body Type : PICK-UP

2. The original body type of the said motor vehicle was “PICK-UP";

3. To address the increasing number of damage, scratches and dents upon the body of my
vehicle and to ensure clean and uniform application of paint upon it, I decided to repaint the
body from its original aspen white into acid yellow met with color code W9Y;

4. The 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 ______________at Tandag

City, Surigao del Sur, Philippines.

YUL BERNIE L. CURADA

Affiant
Philhealth No. 20-000009766-6

SUBSCRIBED AND SWORN to before me this _________________ at Tandag

City, Surigao del Sur, affiant exhibited his ID as proof of identity.

Doc No. ____

Page No. ____
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Series of 2022.