REPUBLIC OF THE PHILIPPINES)

CITY OF PASAY                ) S.S.

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

AFFIDAVIT OF CHANGE COLOR

 I, ___________________, of legal age, Filipino, (single/married/widow) and

a resident of _______________________________, 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 :  ______________
             Motor Number : ______________
             Chassis Number : ____________
             Plate Number : ______________
             MV File No. : ________________
             Year Model :_________________
         Color : _____________________

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

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

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 Pasay City, Metro Manila, Philippines.

____________________
Affiant
SSS 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 2013.