REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA ) S.S.

AFFIDAVIT

I, , Filipino, of legal age, and a resident of

, after having been duly sworn to in
accordance with law, hereby depose and say that:

1. I am the lawful and registered owner of a certain motorcycle that is

more particularly described as follows:

Make :
Engine No. :
Chassis No. :
Series :
MV File No. :
Denomination :

2. The original body design of the Motorcycle is Motor Tricycle under the
denomination of motorcycle with sidecar;

3. To be able to use the said motorcycle in a more convenient manner, I

have decided to remove its side car and convert it to a motorcycle without side car,
and as such, to replace its denomination from “Motorcycle with Side Car” to “Motor
Cycle” for the purpose of its registration;

4. The change of the body design from Motorcycle with Side Car to Motor
Cycle is not intended for any illegal or unlawful purpose but solely due to the
foregoing reasons;

5. That I am executing this Affidavit to attest to the truth of the foregoing

and in support of the application for the change of body design bearing denomination
of the above described motor vehicle on its Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this

in .

Affiant

SUBSCRIBED AND SWORN to before me this 9th day of October 2020,

affiant satisfactorily proven to me his identity through his and,
that he is the same person who personally signed before me the foregoing affidavit
and acknowledged that he executed the same.

Doc No. ;
Page No. ;
Book No. IV;
Series of 2020.