REPUBLIC OF THE PHILIPPINES)

CITY OF _____________ ) S.S.

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

AFFIDAVIT OF CHANGE COLOR

I, Annabel A. Montemayor, of legal age, Filipino, married and a resident of San Miguel,
Cordova, Cebu, 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: Suzuki/ Utility Vehicle

Motor Number: K6A-6933245
Chassis Number: DA64V-171048
Plate Number: 090110
MV File No. : 0901-00000387698
Year Model : 2018
Color : GREY

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

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

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 _______________________________, Philippines.

ANNABEL A MONTEMAYOR
Affiant
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 2019.