AUTHORIZATION

I, ___________, Filipino, of legal age, and a resident of ______________, hereby

authorize ______________, with Philippine Driver’s License No. _________, to utilize, possess,
and operate my motorcycle, registered in my own name as described below:

Make: KAWASAKI MOTORCYLE

Model: BARAKO G ELEC.
Engine No: XXXX
Chassis No: XXXX
Color: XXX

I have executed this AUTHORIZATION to attest to the truth of the foregoing and for all
legal intents and purposes this document may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 28 th day of

October 2016 at Pasig City, Philippines.

______________________
Affiant

Republic of the Philippines)

Pasig City ) S.S.

SUBSCRIBED and sworn to before me this 28th day of October 2016 in Pasig City,
affiant known to me and exhibited to me her ____________________________ valid
until/issued on _________________.

Doc No.
Page No.
Book No.
Series of 2016