REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF SAN REMIGIO) S.S.

AFFIDAVIT OF CHANGE OF ENGINE

WE, SPS. FELIX T. URSONAL and VENEFELMA A. URSONAL, Filipinos, of

legal age, and residents of Looc, San Remigio, Cebu, after having been sworn in
accordance with the law, hereby depose and state that:

1. We own a motor vehicle with the following specifications:

Make: Mitsubishi Type: Dump Truck

Year Model: 1986 Plate No. RCA 995
Engine No.: 8DC9-302232 Chassis: FV415J-510044

2. I, Felix T. Ursonal, as a retired marine engineer and with basic knowledge

in mechanical engineering, recently replaced the old engine with a new
one bearing Engine No. 8DC11511720.

3. We are executing this affidavit to attest to the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, we have signed this affidavit on May 9, 2019 in

Poblacion, San Remigo, Cebu.

______________________ _______________________________
FELIX T. URSONAL VENEFELMA A. URSONAL
Affiant Affiant
UMID No. 000610331897 UMID No. 000620893937

SUBSCRIBED AND SWORN TO before me on the date and place above-

stated where the affiant exhibited to me their competent evidence of identity
printed below their respective names.

Doc No.
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Series of 2019.