REPUBLIC OF THE PHILIPPINES)

CITY OF PASAY ) S.S.

x------------------------------------x

AFFIDAVIT OF CHANGE COLOR

I, ___________________, of legal age, Filipino,

(single/married/widow) and a resident of
_______________________________, after having
been duly sworn to in accordance with law, depose and
state THAT:

1. I am the registered owner of a motor vehicle which is

particularly described as follows:

Make & Type : ______________

Motor Number : ______________
Chassis Number : ____________
Plate Number : ______________
MV File No. : ________________
Year Model :_________________
Color : _____________________

2. The original color of the said motor vehicle was

"_____________";

3. 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. 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 motor vehicle on its
Certificate of Registration.

IN WITNESS WHEREOF, I have hereunto set my hand

this ___________________ in Pasay City, Metro
Manila, Philippines.

___________________
_
Affiant
SSS ID No.
_____________

SUBCRIBED AND SWORN TO before me

this ___________________ in
_________________, Philippines, affiant exhibiting to
me his/her competent evidence of identity by way of
__________________ issued at ______________
on __________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013