REPUBLIC OF THE PHILIPPINES)

CITY OF PASAY ) S.S.

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

AFFIDAVIT OF CHANGE COLOR

I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of _______________________________, 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 : ______________

Motor Number : ______________

Chassis Number : ____________

Plate Number : ______________

MV File No. : ________________

Year Model :_________________

Color : _____________________

2. The original color of the said motor vehicle was "_____________";

3. When the paint of the above-described motor vehicle had faded, I had its color repainted to "_________" such that the color of the said motor vehicle was changed from "_________" to "________";

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 Pasay City, Metro Manila, Philippines.

_________________________

Affiant

SSS ID No. _____________

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.