REPUBLIC OF THE PHILIPPINES

Department of Transportation and Communications

LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
East Avenue, Quezon City

NOTICE OF CHANGE OF ENGINE

FILING DATE : ________________________

CASE NUMBER : ________________________

NAME OF OPERATOR/REPRESENTATIVE: _____________________________________________

COMPLETE ADDRESS: ___________________________________________________________________

TYPE OF SERVICE: _____PUJ _____TX _____PUB _____VFH _____SB

_____SHB _____TB _____TH _____TTS

SECTION A: Information on Record with the Board

Details of Authorized Units

Make: Motor Number:

Chassis Number: Plate Number:

Engine Number:

Section B: Requested Change

New Engine Number:

I/We ____________________________________________, certify that all information contained

herewith are true and correct.

_______________________________________________________
Signature of Operator/Authorized Representative

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Do not write beyond this point

Remarks:
__________________________________________________________________________________
__________________________________________________________________________________

This is to certify that the records of the Board with regard to herein requested change has
already been modified/ updated.

Date: _________________________ _____________________________________

Chief, Management Information Division

cc Applicant, MID, TED, OCHM