Republic of the Philippines)

Province of ____________________)S.S.
City/Municipality of _____________)
x-----------x
AF FI D AV I T

I, _____________, Filipino, of legal age, (single / married / widow), and a resident of

_____________, Philippines, after being sworn to in accordance with law, depose and state:
1.That I am the registered owner of a certain motor vehicle that is more particularly described as
follows:
Make:Motor No.:
Type:Chassis No
Color:Plate No.:
2.That the original color of the said motor vehicle was "_____________";
3.That 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.That said change of color is not intended for any illegal or unlawful purpose but solely due to
the foregoing reasons;
5.That 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 ___th day of April 2016 at
____________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of April 2016 in ___________,
Philippines, affiant exhibiting to me his competent evidence of identity by way of
________________ issued at ___________ on ______________.

Notary Public

Doc No. : _____

Page No.: ______
Book No.: ______
Series of 2016