Republic of the Philippines)

______________________) S.S.

AFFIDAVIT OF ADMISSION

I, MILDRED T. RAMIREZ, of legal age, Filipino citizen and with address at

Block 29, Lot 6B White Gardenia St., Brgy. Lapidario, Trece Martires City, Cavite,
after having been duly sworn in accordance with law, hereby depose and say:

That I am the registered owner of one (1) unit motor vehicle, to wit:

Make/Type : Toyota Hi Ace Commuter Van

Conduction Sticker No. : YY 1567

Color : Silver

Engine Number : 1KD2592915

That on March 27, 2018 at around 7:05 am, the aforesaid vehicle was
apprehended for the alleged violation of “colorum” along Pasay Taft, Rotonda;

That I hereby admitted that the aforesaid vehicle was operated as

“colorum”;

That I am executing this affidavit to attest to the fact of the foregoing

statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____day of June,

2018 at Trece Martires City, Cavite.

MILDRED T. RAMIREZ
Affiant

SUBSCRIBED AND SWORN to before me this _________day of June 2018

in ___________________________.

NOTARY PUBLIC

DOC. NO.________;
PAGE NO.________;
BOOK NO._______;
SERIES OF 2018.