REPUBLIC OF THE PHILIPPINES )

IN THE CITY OF ANGELES ) S.S.

AFFIDAVIT OF CHANGE OF ENGINE

I, ____________________, of legal age, Filipino, ____________________, and

residence and postal address at _____________________, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am a mechanic by profession;

2. That my service was contracted by Mr. _____________________, of

_____________________, to change the engine of his motor vehicle which is more
particularly described as follows:

Make --------------
Type --------------
Motor No. --------
Serial No. ---------
Plate No. ----------
New ---------------

3. That the new engine to be installed is own by said ______________________,

bearing the Engine No. ___________;

4. That the change of engine was recently completed and I can vouch as to its
roadworthiness;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to
facilitate the registration of the above-mentioned motor vehicle of its new engine.

IN WITNESS WHEREOF, I have hereunto set my hand this __________ day of

___________, at Angeles City.

__________________
Affiant

SUBSCRIBED AND SWORN to before me in the City/Municipality of

____________________ this __________ day of __________ by ___________________,
who has satisfactorily proven to me his identity through his ___________________ valid
until __________, that he is the same person who personally signed before me the foregoing
affidavit and acknowledged that he executed the same.

Notary Public
Until Dec. 31, 20
Doc. No. ______; Roll of Atty.’s No.
Page No. ______; IBP Lifetime Member No.
Book No. ______; PTR No.
Series of 2009. Com. No.
1282 Miranda St., Angeles City