REPUBLIC OF THE PHILIPPINES )

CITY OF BACOLOD )
X------------------------ X

JOINT AFFIDAVIT
(Change Body)

We, JOSE RODOLFO N. TIU II and RODOLFO P. SERMON both of legal ages, Filipino, and
both residents of Bacolod City Negros Occidental, Philippines after having been duly sworn to an oath do
hereby depose and say;

That I, JOSE RODOLFO TIU II. is the registered owner of motor vehicle more particularly
described as follows:

Make/ Type : FUSO CANTER REBUILT TRUCK

Motor No. : 4D36D86383
Chassis No. : FE516BD400874
Plate No. : T-071610
MV File No. : 0716-00000563215

That I have changed the BODY DESIGN of the aforementioned motor vehicle from REBUILT
TRUCK to MINI DUMP TRUCK;

That I hired the services of RODOLFO P. SERMON, a lathe man by profession to do the job in my
behalf;

That I, RODOLFO P. SERMON, a lathe man by profession, was hired by JOSE RODOLFO TIU II,
to change the Body Design of the aforementioned motor vehicle from REBUILT TRUCK to MINI DUMP
TRUCK.

That we are executing this affidavit in order to attest to the truth of the foregoing facts and to
request the PNP Highway Patrol Group to issue a clearance for the changing the Body Design of the
above- described motor vehicle.

IN WITNESS WHEREOF, we have hereunto set our hands this __________________________ at

Bacolod City, Philippines.

JOSE RODOLFO TIU II RODOLFO P.SERMON

Owner Lathe Man

SUBSCRIBED AND SWORN to before me this ______________________________ at Bacolod City,

Philippines.

Doc. No._______________;
Page No._______________;
Book No. ______________;
Series of 2022