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REPUBLIC OF THE PHILIPPINES) PROVINCE OF BULACAN ) S.S.

AFFIDAVIT OF WARRANCY

That We, EVELYN & VIDAL HERNANDEZ JR. of legal aage, Filipino, and resident of 32 Purefoods Rd. San Roque City of Marikina,after having been duly sworn tom in accordance with law ,depose and say: That I am the lawful owner of a certain motor vehicle more particularly described as follows:

MAKE / TYPE MOTOR NUMBER CHASSIS NUMBER FILE NUMBER PLATE NUMBER C.R. NUMBER

: : : : : :

Isuzu / Wing Van 10PD1-758287 CXM71V-3003223 0386-50882 CTR917 21457484

That by virtue of this affidavit, I hereby declared and manifest that I am the lawful owner of the said motor vehicle and I take all the responsibility resultant of this warranty and I hereby free the LTO and its personnel in case ther would be third party claims arises:

That I am executing this affidavit to attest confirm the truth of the foregoing statements and or whatsoever legal intents and purpose which the same may serve.

FURTHER,AFFIANT SAYETH NAUGHT.

SUBCRIBED AND SWORN to before me this _________ day of _____20 at __________________.

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