AFFIDAVIT

I, _____________, Filipino, of legal age, (single / married / widow), and a resident

of _____________, Philippines, after being sworn to in accordance with law,
depose and state:

1.That I am the registered owner of a certain motor vehicle that is more

particularly described as follows:

Make:Motor No.:
Type:Chassis No
Color:Plate No.:

2.That the original color of the said motor vehicle was “_____________”;

3.That 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.That said change of color 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 color of the above-described
motor vehicle on its Certificate of Registration.