Republic of the Philippines)

City of Masbate )S.S.

AFFIDAVIT

I, PERLITO S. SOLER, of legal age, Filipino, married, and a resident of Brgy.

Crossing, Uson, Masbate, after having been duly sworn to in accordance with law,
hereby depose and state:

1. That I am the new owner of a motorcycle with the following particulars:

Make: Motorstar
Chassis No.: LAAAAKJB7C0004205
Plate No.: 052802
MV File No.: 0528-34894;
2. That I acquired it by virtue of a Deed of Absolute Sale dated September
19, 2016 duly executed between the previous owner, Lilia M. Dublin and
I;
3. That said motorcycle was previously registered as Motorcycle without
side car;
4. That I now desire to have the said motorcycle be registered as a
motorcycle with side car;
5. That I am executing this affidavit to attest to the truth of the foregoing
facts.

IN WITNESS WHEREOF, I hereby affix my signature this 28th day of

September, 2016 at Masbate City, Philippines.

PERLITO S. SOLER
Affiant

SUBSCRIBED AND SWORN TO before me this 28th day of September, 2016

at Masbate City, Philippines.

ATTY. MA. THERESA A. LEGASPI- VALENCIA

Public Attorney II
Pursuant to R.A. 9406

Doc No. _____;

Page No. ____;
Book No. _____;
Series of 2016.