REPUBLIC OF THE PHILIPPINES)

Province of La Union ) Sc.

Municipality of Tubao )

AFFIDAVIT OF CHANGE COLOR

KNOW ALL MEN BY THESE PRESENTS:

I, NINO RAPISURA BANGCONG, of legal age, married, Filipino citizen and a

resident of Halog West, Tubao, La Union, after having been duly sworn to in accordance with
law, do hereby depose and state, that:

1. I am the vendee of the following vehicle which is more particularly described as

follows:

MAKE AND SERIES ----------- Totoya

TYPE OF BODY ----------------- Jeep
MOTOR NO.: -------------------- 3A-1194749
SERIAL/CHASSIS NO. --------- EXL-95120349-C
Year Model: ------------------------- 1996
PLATE NO.: ----------------------- CMV339
MV FILE NO. 0304-00000044423

2. Just recently, I caused the change of the COLOR of the above-mentioned motor
vehicle from GALVANIZED TO BLUE;

3. The changes mentioned above were not aimed to conceal a crime or violation of the
Land Transportation Code, Traffic Laws and Regulations or the Revised Penal Code
of the Philippines, but was principally for personal reason and satisfaction;

4. I am executing this Affidavit to attest to the truthfulness and veracity of the foregoing
narration of facts; and for whatever legal intents and purposes this may well serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of March,
2019 at Tubao, La Union, Philippines.

NINO RAPISURA BANGCONG

Affiant
UMID ID No. 0008-1243542-3

SUBSCRIBED AND SWORN to before me this 14th day of March 2019 at Tubao, La
Union by the affiant appearing personally and who is known to me to be the same person who
executed this affidavit.

ATTY. JOONEE RANDYL E. RIVERA

Notary Public until December 31, 2020
Doc. No.: 99; Aspiras Highway, Francia Sur, Tubao, La Union
Page No.: 21; Roll No. 61766, TIN 929-347-628
Book No.: XX; PTR No. 3713479, 01-03-19, Tubao, LU
Series of 2019. IBP Life Member No. 012553; 01-02-14, SFLU
Commission No. ANC-2018-51
MCLE No. VI-0004746, 12/06/17