AFFIDAVIT OF CHANGE ENGINE

______________________________ represented by __________________________, of legal

age, Filipino, single and a resident of_______________________________________________, after
having been duly sworn to in accordance with law do hereby depose and say:

1. That I am the legal owner and possessor of a motor vehicle particularly described as:

Make & Type ------------------------------------ _____________________

Serial/Chassis No.: ----------------------------- _____________________
Engine No.: --------------------------------------- _____________________
Color: ---------------------------------------------- _____________________
Plate No.: ----------------------------------------- _____________________

2. That I caused the change of the engine of the above-described motor vehicle from
_____________ to _____________.

3. That ______________________ of _________________________________was the one

who changed the ENGINE of the above-described motor vehicle;

4. That I execute this affidavit to attest to the truth of the above facts and circumstances and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF , I HAVE HEREUNTO SET MY HANDS THIS ____ DAY OF

_______________ 20__, AT ___________________________.
 

_____________________________
Affiant

  ACKNOWLEDGEMENT

Republic of the Philippines )

 _____________________) S.S
 

SUBSCRIBED AND SWORN to before me this ______ day of ___________, 20___

at ____________________________________.

            
    

Doc. No.______;
Page No. ______;
Book No.______;
Series of 20___.