REPUBLIC OF THE PHILIPPINES
Department of Transportation and Communications
LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
East Avenue, Quezon City
____________________________________________,
CASE NO. _______________________
Petitioner
x ------------------------------------------------------------------------- x
PETITION FOR CHANGE OF CHASSIS
P E T I T I O N
COMES NOW, Petitioner in the above-entitled case and unto this Honorable Board most respectfully state/s
that:
1. That
Petitioner
is
of
legal
age,
Filipino,
and
has
postal
address
at
______________________________________________________________________________.
2. That Petitioner is a grantee of Certificate of Public Convenience (CPC) lawfully granted to operate
________________________ service on the line _______________________________________
under Case No. _____________________________ with the use of ____________________(
)
unit/s hereunder described, to wit:
MAKE
MODEL
MOTOR NO.
CHASSIS NO.
PLATE NO.
3. That Petitioner/s desires to change Chassis from :
PRESENT CHASSIS NUMBER
NEW CHASSIS NUMBER
4. That the new abovementioned Chassis was acquired from _____________________________ with
sales invoice number: ____________________ /or Deed of Sale dated _______________________.
5. That public service and convenience will be served most in a proper and suitable manner with the
approval of this petition;
WHEREFORE, it is respectfully prayed that after due consideration, the foregoing petition be approved.
___________________________________________.
________________________________
Petitioner
W A I V E R
I, (name of petitioner), hereby grants authority to LTFRB, to verify the authenticity of all the documents
herein submitted together with this petition from both government and private sources.
________________________________
Petitioner
V E R I F I C A T I O N
I/
WE
____________________________________
Filipino
and
with
business
address
at
___________________________________________________ after having been duly sworn to in accordance with
law hereby depose and say: That I/WE am/are the petitioner/s in the above-entitled case; That I/WE have caused
the preparation of the foregoing application and have read the contents thereof; and the same are true to the best of
my knowledge and belief.
________________________________
Petitioner
SUBSCRIBED
AND
SWORN
to
before
me
this
________
day
of
_______________
at
____________________
Affiant
exhibited
to
me
his
_______________________
issued
at
____________________ on __________________________.
Doc No.
:
_________
Book No. : _________
Page No
:
_________
Series of : _________