REPUBLIC OF THE 

PHILIPPINES)
CITY OF OZAMIZ             ) S.S.

AFFIDAVIT OF CHANGE OF COLOR 

I, ARSENIO A. SINGIDAS, of legal age, Filipino citizen, married and a resident of
Purok 1, Basirang, Tudela, Misamis Occidental, Philippines, after having been duly sworn
to in consonance with law, hereby depose and say, That:
 
1. I am the registered owner of a certain vehicle, which is more particularly
described as follows:
Certificate of Registration: 39521709-3 Date of Registration: 12/14/2020
MV File No: 1017-00008097404 Plate No: KAJ4895
Engine No: R2-754782 Chassis No: SE28M-702281
Make: MAZDA Series: BONGO
Body Type: DROPSIDE Year Model: 2019
Official Receipt No: 2008235574 Date: 12/14/2020

2. The original color of the said vehicle was “BLUE”;

3. When the paint of the above-described vehicle had faded, we had its color
repainted to “YELLOW”, such that the color of the said vehicle was changed
“BLUE” to “YELLOW”;

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 vehicle on its
Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand this 6th day of March,

2021 in Ozamiz City, Misamis Occidental, Philippines.

ARSENIO A. SINGIDAS
Affiant
SSS ID No. 08-0940185-5

SUBCRIBED AND SWORN TO before me this 6th day of March, 2021 in Ozamiz

City, Misamis Occidental, Philippines.

HEINJIE B. ESTAÑO
NOTARY PUBLIC
FOR THE CITY OF OZAMIZ AND THE MUNICIPALITIES
OF CLARIN AND TUDELA, MISAMIS OCCIDENTAL
UNTIL JUNE 30, 2021 PER BM# 3795; 12/1/20
PTR NO. 0003818; 1/8/21, TUDELA, MIS. OCC.
Doc. No. 118; IBP LIFE NO. 07446
Page No. 25; ROLL NO. 54830
Book No. XXVI; TIN-265-961-014-000
Series of 2021.