REPUBLIC OF THE PHILIPPINES)

CITY OF EL SALVADOR ) S.S.

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

AFFIDAVIT FOR CHANGE OF BODY

OF MOTORCYCLE

I, ANNA LOU ARANGOSO UDARBE, of legal age, Filipino, married and a resident of Zone 1, Brgy.
Taytay, El Salvador City, Misamis Oriental, 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 : YAMAHA

Motor Number : E3W7E0111034
Chassis Number : PA0RE3210K0111531
Plate Number : 100105 (TEMP)
MV File No. : 1001-00000418608
Model: YTX 125 BR 21 Year 2019
Color: Black

2. The original body type of the said motor vehicle was "WITHOUT SIDE CAR";

3. To have more use of the said vehicle in my business, I have decided to change the body type of the said
vehicle from "WITHOUT SIDE CAR" to "WITH SIDE CAR";

4. The change of body type is not intended for any illegal or unlawful purpose but solely due to the foregoing
reason;

5. I engaged the services of RICARTE DONDA PANHAY, with his shop located in Brgy. Puli, Carmen, to
perform the body works in order to facilitate the body conversion into "WITH SIDE CAR";

6. I am executing this Affidavit to attest to the truth of the foregoing and in support of the application for the
change of body type of the above-described motor vehicle on its Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in El

Salvador City, Philippines.

ANNA LOU ARANGOSO UDARBE

Affiant
Gov’t. ID No. _________________

WITH MY CONFORMITY:

RICARTE DONDA PANHAY

MOTORCYCLE BODY BUILDER
Gov’t. ID No.:___________________

SUBCRIBED AND SWORN TO before me this ___________________ in El Salvador

City, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.