REPUBLIC OF THE PHILIPPINES
QUEZON CITY )S.S
AFFIDAVIT TO CORRECT NAME
1. _____________________________________________________________________________of legal age ,
Filipino, with office address________________________________________ after having been duly sworn in
Accordance with law hereby depose and state.
1. I am applying for the Correction of Name of a certain vehicle which is more particulary
Described below as:
MAKE :________________________________
ENGINE :________________________________
CHASSIS :________________________________
MV FILE :________________________________
2. That the correct name of the unit is ________________________ and not _______________________
3. The discrepancy was committed by the agent who supplied the foregoing fact indicated in the invoice as
well as on the Certificate of Cover wherein registration would be based.
4. This affidavit is being executed to attest the veracity of the foregoing statement that the correct name of
the ____________________ is _________________________and not ____________________________
only for the information and guidance of the authorities concerned and for whatever legal purposes this
may serve.
FURTHER AFFIANT SAYETH ONE
IN WITNESS WHEREOF, I have here into set my hand this _________ day of _________,20 in the City of
Manila,Philippines.
_________________________________
AFFIANT
SUBCRIBED AND SWORN TO Before me this __________ day of __________,20 , at city of Manila
AFFIANT Exhibiting to me his/her Community Tax Certicate No.___________ ___ issued at ____________
On _____________
Doc No, _________
Page No. _________
Book No. _________