Republic of the Philippines }

City of Cebu }

AFFIDAVIT OF JUNK

I, ___________________, Filipino, of legal age, married, and a resident of

___________________, having been duly sworn in accordance with law, hereby depose
and state that:

1. I am the owner of a motorized tricycle and its franchise with ___________________;

2. The motorized tricycle covered by the said franchise is more particularly

described as follows:

Plate No. : ___________________

3. However, the above-described motor vehicle is now unfit for transportation

purposes, out of running condition, could no longer be used for the above
purposes, and thus now considered junk;

4. I attached the side car of the above-described motor vehicle to a new unit more
particularly described as follows:

___________________
5. I also intend to operate this new unit under the same franchise as listed in
paragraph 1 hereof;

6. I am executing this affidavit to attest to the truth of the foregoing facts, and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have set my hand this ___________________.

___________________
Affiant

SUBSCRIBED AND SWORN TO before me this ___________________in Cebu

City, Philippines, affiant having exhibited to me his competent evidence of his identity.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2019.