REPUBLIC OF THE PHLILIPPINES )

PROVINCE OF SULTAN KUDARAT ) S.S.

MUNICIPALITY OF ISULAN )
x- - - - - - - - - - - - - - - - - - - - - - - - - - - X

AFFIDAVIT OF CHANGE OF BODY TYPE OF

MOTORCYCLE

I, EDWIN G. SUMARIBOS, of legal age, Filipino, single, and a resident of Dukay,

Esperanza, Sultan Kudarat, after having been duly sworn to in accordance with law do
hereby depose and say:

1. That I am the legal owner and possessor of a motor cycle particularly described
as:

Make & Type- - - - - - - - -- - - - KAWASAKI/MC

Serial/Chassis No. - - - - - - - MD2A18AZ5EWJ62105
Engine No. - - -- - - - - - - - - - - - DUZWEJ25968
Color - - - - - - - - - - - - - - - - - - - RED
Plate No - - - - - - - - - - - - - - - - MC42914

2. That I caused the change of the body type of the above-described motor cycle
from WITHOUT SIDECAR to WITH SIDE CAR.

3. That I execute this affidavit to attest to the truth of the above facts and
circumstances and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 11 th day of April, 2017 at
Isulan, Sultan Kudarat.

EDWIN G. SUMARIBOS
Affiant
TIN: 446-152-123

SUBSCRIBED AND SWORN to before me this 11th day of April, 2017 at Isulan, Sultan
Kudarat.

ARNOLD H. ARMADA
Notary Public
Doc. No. 127 Until December 31, 2018
Page No. 27 In the Province of Sultan Kudarat
Book No. 140 RTC Isulan Misc. Case No. 293
Series of 2017 PTR NO. 2589411/01-03-17/Isulan
IBP NO. 952292/ 11-10- 2016 /Isulan
ROLL NO. 38861/3-14-1994
TIN: 950-570-511
Lao Bldg., Valencia St., Kalawag II,
Isulan, Sultan Kudarat