GENERAL AFFIDAVIT REPUBLIC OF THE PHILIPPINES ) _____________________________ ) SS.

I, _____________________________, Filipino, of legal age, single/married to _____________________________/widow/widower, and a resident of _____________________________, after having been duly sworn in accordance with law, hereby depose and say: 1. That I am the actual buyer of that motor vehicle which is specifically described as follows: MAKE: SERIES: TYPE OF BODY: YEAR MODEL: C.R. NO.: MOTOR NO.: SERIAL/CHASSIS NO.: PLATE NO.: FILE NO.:

2. That the fact of purchase is evidenced by that Deed of Sale of Motor Vehicle dated _____________________ whereby _____________________ is the vendor and I am the vendee as entered in the notarial register of Notary Public _____________________ as Doc. No. ___, Page No. ___, Book No. ____, and Series of 20___, a copy of said Deed of Sale is hereto attached for reference; 3. That I hereby attest to the authenticity of said Deed of Sale and the genuineness of the transaction and in furtherance thereof, I hereby release the officers and staff of the Land Transportation Office from any liability which may occur in the event that there is any flaw or legal infirmities in said transaction; 4. That I am executing this affidavit in order to attest toe the veracity of the foregoing circumstances and as a warranty on the authenticity and genuineness of the above mentioned transaction. IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at ____________, Philippines. _________________________________ (Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________ 20___. The affiant, whom I identified through the following competent evidence of identity: _____________________________, valid from ______________ to ______________ issued by ____________________________, personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument. Notary Public

Doc. No. ........; Page No. .......; Book No. .......; Series of 20_