REPUBLIC OF THE PHILIPPINES

CITY OF OLONGAPO …………..)S.S.

AFFIDAVIT OF CHANGE COLOR

That, Muhammad Ammar, with postal address at Rm 320 Topaz Bldg Crown Peak Garden
SBMA Zambales 2200, after having duly sworn to in accordance with law, hereby depose and say;

That, Muhammad Ammar is the registered owner of which is more particularly described as
follows.

MAKE : ISUZU FORWARD

TYPE : WINGVAN
CHASSIS NO. : FRR34L4-7005523
ENGINE NO. : 6HK1-848678
PLATE NO. :

That I am executing this affidavit to request for the CHANGE COLOR of the said motor vehicle and that
the modification was made without any cost.

FROM YELLOW TO TORTOISE

IN WITNESS WHEREOF, I have hereunto affixed my hand this ________ day of ________ 2018 in O.C.,
Philippines.

MUHAMMAD AMMAR

Presented by: ________________________

AFFIANT

This day personally appeared before me ______________________ with ______________________

issued on _______________ at ____________________and acknowledged to that the same is his free
and voluntary act and deed.

Doc. No.________
Page No.________
Book # ________
Series of ________