REPUBLIC OF THE PHILIPPINES)

CITY OF LEGAZPI
) S.S.
x------------------------------------x

AFFIDAVIT OF ATTACHMENT FOR SIDECAR

I, Ruel L. Balisnomo of legal age, Filipino citizen and resident of Brgy. San Roque,
Santo Domingo, Albay after having sworn to in accordance with law, hereby depose
and say;
1. That I am the SIDECAR MAKER of a motorcycle more particularly described as
follows:
REGISTERED TO
MAKE
TYPE
MOTOR NUMBER
CHASSIS NUMBER
COLOR

:
:
:
:
:

DATE OF COMPLETION
OF SIDECAR

HUBERT B. LANA, JR.

HONDA
TMX150 (2G)
KYAO1E-036674
KYAO1036628
BLACK
NOVEMBER 2015

2. That the above-describe Brand New Motorcycle was converted to a Motorcycle

with Sidecar (TC) for private use/Business;
3. That I am executing this affidavit to attest to the foregoing statements for
registration purposes only.
IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of December
2016 in Legazpi City, Philippines.

____________________
Affiant
Drivers License No. E02-04-045836
SUBCRIBED AND SWORN TO before me this 20th day of December
2016 in Legazpi City, Philippines, affiants exhibiting to me his valid proof of
identification.
Doc. No. _____;
Page No. _____;
Book No. _____;

Series of 2016.