Republic of the Philippines )

Province of Batangas ) S. S.
Municipality of San Jose )

AFFIDAVIT
I ALC, of legal age, Filipino and with address at Brgy, Banay-Banay 1, San
Jose, Batangas, after having been sworn to in accordance with law, hereby depose and
state that:

1. I am the registered owner (sole proprietor) of ALC PAINT & BODY

REPAIR SHOP located at San Jose, Batangas;

2. The said shop was commissioned by XXX Feeds Corp. to paint/change the
color of a certain motor vehicle, more particularly described as follows:

MV File No. 9012345678

Plate No. Abc 123
Engine No. 4dfakgwe
Chasis No. xxxx
Make/Series Truck

3. Originally, the color of the subject vehicle was gold, and our shop has
painted the same with Green and White.

4. I am executing this affidavit to attest to the truthfulness of the foregoing

declarations, to support XXX’ application for change of color of the said
vehicle/Truck, and for all legal intents and purposes.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____________2020 at San Jose, Batangas.

ALC
Affiant

SUBSCRIBED AND SWORN TO before me this ________________at San Jose,

Batangas, by the affiant who exhibited his competent evidence of identity ID No.
__________________________________.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2020