REPUBLIC OF THE PHILIPPINES…)

CITY OF ZAMBOANGA ….. .. . . . . .) S.S.

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AFFIDAVIT DISPOSAL OF MOTORIZED VEHICLE

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

___________________, after having been sworn to in accordance with law, hereby depose and
state:

1. That on July 3, 2017, I acquired a motorized vehicle particularly described as

follows:

Make :
Type of Body :
Serial/Chassis No. :
Engine No. :
Plate No. :
MV File No. :

2. That said vehicle was used as public transport, however, due to constant
breakdown it was not operated regularly;

3. That for the above preceding reason, sometime in December 2017, I decided to
dispose/sell the above stated motorized vehicle for a junk price;

4. That I execute this Affidavit freely and voluntarily to attest to the truthfulness of
the foregoing facts and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my signature this
________________________________ at Zamboanga City, Philippines.

_________________
Affiant

SUBSCRIBED AND SWORN to before me on the above-written date and place.

Doc. No._______;
Page No._______;
Book No._______;
Series of 2018.