REPUBLIC OF THE PHILIPPINES DEPARTMENT OF TRANSPORTATION LAND TRANSPORTATION OFFICE East Avenue, Quezon City APPLI FORM (Driving School Instructor) Pursuant to MC No, 2019-2176 [Z]_ New [[] RENEWAL Accrecitation Control No.: APPLIED FOR: [_] PRACTICAL DRIVING INSTRUCTOR CLASSROOM INSTRUCTOR [7 BoTH / DATE: July 04,202) NAME OF APPLICANT: YaT Ay OS EPH SUALO Banana) Tian) Goa aooress: 219 Fulerol ¢7. “ER Bromma "enact no: OA AeA 9 ANG 7G DATE OF BIRTH: a= [gC Sex: IW CITIZENSHIP: E(Cipho_civiL sTaTUS e DRIVER'S LICENSE NO: KO72140 [0614 exetraTion:2 [19/2024 pu cove: 112 NAME OF DRIVING SCHOOL: MMANEJO_ CENTRE TECHNICAL CoheaL NC. REGION: SZ DS ACCREDITATION CONTROL NO. VEHICLE CATEGORY: MoToRCYCLE —[V] LIGHT VEHICLE HEAVY VEHICLE AAL 581,82 6,0 HIGHEST EDUCATIONAL ATTAINMENT: Name of Schoo! Inclusive Dates of Attendance | Degree Earned UB EAD COLLECE of Woe - 261d Mast Ia ldwtal ey ‘SEMINAR/TRAININGS (for the last five years): “Training Course Name of Training Center Date Acquired iW. —-- IK On Eley ic, Leavin, CGM Cal JULY 6}, 202d Ain OL T2 trae Con cal fry e Ig il Dee At EXPERIENCE AS DRIVING SCHOOL INSTRUCTOR: Inclusive Dates, naa a Name of Schoo! bY 20} CAG COLUE GE ou 20) G1 C * Please read the qualifications and requirements at the back of this application. 1 hereby certify that the foregoing statements and information are true and correct, and accomplished in my own handwriting. I understand that I will be liable for perjury for any false statement or entries and the driving school will be permanently disqualified as a result theredf. >) IN WITNESS WHEREOF, I have here unto set my hand this at Subscribed and sworn to me this Certificate No. (ese Doc. No. Page Book No. Series of011510070820210165 Republic ofthe Philippines Department of Transportation Land Transportation Office East Avenue, Quezon City Cabadbaran District Office CERTIFICATION July 08, 2021 TO WHOM IT MAY CONCERN: THIS IS TO CERTIFY that according to existing records of this Office, Mr/Ms. JOSEPH S. YATAN a resident of has the following driver's license data License Type : Professional License Number —:_(KO7-94-010614 O.R. Number : Date Issued Amount Paid Agency, : Surigao City, Surigao del Nor. Lic Expiry Date : 03-18-2024 Restriction Code/s :_-R1 MOTORCYCLES/MOTORIZED VEHICLE R2 VEHICLES UP TO 4500 KGS G VW Condition/s Date of Birth 1 03-18-1975 icense to drive since : Year Two Thousand Three ( 2003 ) Itis further certified that the above named person has no pending traffic violation / apprehension case/s as of the above date. Issued upon request of Mr. / Ms. J.YATAN for the purpose of For AlfLegal Intent and Purposes For the Assistant Secretary Edgar C. Galvante Eugene P. Head, License Section (Or No, 002021210450060 ‘Amount Paid: PHP 100.00 Date ‘July 08, 2024 Control No, THIS CERTIFICATION IS VALIO ONLY when signed by an autherzed LTO Ofc without erasures and supported by an offal acl payment.DEPAR MEN) \ LAND TRAt \ East avenue cme | Field Office: OFFICIAL RECEIPT epublcofthe Priiopoas "SN iT OF TRANSPORTATION NSPORTATION OFFICE ‘asses chy ot Field Office Code: - 1551470896 gare2002 “p-40h Jo Mop Jin sounddryd ‘x12 ovbams ' 21 Jo eBa.0D ays ovbrms 20 a9! urchiiedtnanmaing tuouoy pre tobopinig wba me een / ASOTONHDSL SAILOWOLNY ” “H f NOILVONGS “IVINLSNGNI Ni SONAIOS JO 4O13HOVE ) ; ; 40 eurbod op pazwasB neo Kop 4g oy huey an pages Kuoymy Bs " ap 49 (pwn som 40 preog mp Jo yorasddo mp Kzmov4 majo uomepwaunuose wn ommant 2 semen mayoral ng mide spun Bunny NM Ung Ss ydas0g 8 “QM awopsovoy SBNILARND ‘WOd |/DYS Syuasaud asayy WoYM |]0 oO, @ wr % 07, ane as ONHOL 4 ADE TION BINIS OFRepublic of the Philippines SURIGAO STATE COLLEGE OF TECHNOLOGY OFFICE OF THE REGISTRAR ‘Sungao City Telephone No. (086) 232-5446 OFFICIAL TRANSCRIPT OF RECORDS September 77, 2010 DATE Name TAN, Joseph Suazo Home Address: 212 Funcion, AON Birth Place __Po-oe, Talisayan, Misamis Onentat Birth Date Etementary Schoo! Completed: Mot indicated _ High School Course Completed: —_Candelaria inetitute __ TESHIPTION OF COURSES NORTHERN WINDANRO COLLEGE OF ABTS, SCHNCE ™ Me MADRARAN CaNtOUS | CARADRARAN. AGUSAN DEL NONTE Lene nd tac. Yow Tectociogy mith Cerificate of Proficiency in Adtomaife Tech on arn 231995 We COLLEGE OF TECHNOLOGY - Serigze Cit DLO OF SCRENCE IN INDUSTRIAL EDUCATED ‘Year BACHELOR OF SCIENCE IN INDUSTRIAL EDUCATION (BSIF), DEGREE SVE TECHNOLOGY, Bach 7207 ower iss fara ented *esuance of Special Order for Graduation” fs hereby amend sent om Stand at pote senoct, ete genera ih schools, vocal edane Leconaor tcnrch ara vocations ehocte and colleges feng degree Sumlno SHATE COLLEGE OF TEGHNOLOGY - Serigue Ci Research Methodology Inferentia) Statistics Creative Education Teaching and Leaming Paradiam ‘Quantitative Qualitative Techniques Phito-Socio Foundation of Education \w/ Trends & lesues in Industrial Education Technology 1 (Automotive Technology) Phil. Society and Culture Industrial Component at Fast Autowortd Phils. Corp. Km.3.1.C. Aquino Ave., Butuan City Curriculum Dev't. and Evaluation Technology !! (Automotive Technology) “DETERMINANTS IN THE OFFERING OF SHORT TERS ‘COURSES IM SURIGAO STATE COLLEGE OF TECHN SURIGAO CITY: BASIS FOR THE ADOPTION OF TECHNICAL TRAINING DESIGN™ INDUSTRIAL EDUCATION Major in AUTOMOTIVE TEG) epereeay »SPECIAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: 1, JOSEPH S. YATAN, resident of Barangay 3, Cabadbaran City, all of legal age, Filipinos, have named, constituted and appointed RONETTE ELANO, likewise a Filipino citizen, of legal age, and a resident of Surigao City, Philippines, to be our true and lawful Attomey-In-Fact, and for that purpose, in my name and in our behalf, to do and perform all or any of the following acts, deeds, and things, to wit 1. To TRANSACT and PROCESS and CLAIM my Qualification Certificate of f my Driving NC2 from Regional TESDA Office of Surigao City and the renewal of my Automotive Servicing NCI, Automotive Servicing NC2, Trainers’ Methodology 1; HEREBY GIVING AND GRANTING unto the said Attomey-in-Fact full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the preqmises and hereby ratifying and confirming all that the said Attorney- in-Fact shall lawfully do or cause to be done by virtue of this Special Power of Attorney. IN WITNESS WHEREOF, we hav¢ affixed our signatures this July 09, 2021 at Cabadbaran City, Agusan del Norte, Philippin: JOSEPH'S-YATAN Principal ACCEPTED BY: RONETTE ELANO Attorney-In-Fact ACKNOWLEDGMENT BEFORE ME, a Notary Public, personally appeared the foregoing persons, all personally known to me and whom I have identified through the foregoing competent evidence of identity and who represented to me that their respective signatures on the foregoing instrument were voluntarily affixed by them for the purposes stated in the instrument and who declared that they have executed the foregoing instrument as their free and voluntary act and deed, WITNESS MY HAND AND SEAL this July 92624 aCity, Agusan del Norte, Philippines. Doc. No. [9S2; Page No. 20; Book No.XV: Series of 2021.REPUBLIC OF THE PHILIPPINES ) Province of Agusan del Norte) S.S. City of Cabadbaran ) AFFIDAVIT OF LOSS I, JOSEPH S. YATAN of legal age, Filipino and a resident of Brgy 3, Cabadbaran City, Agusan del Norte, Philippines, after having been duly sworn in accordance with law, hereby depose and state: 1, That I finished my Vocational Course at Regional TESDA Office of Surigao City and that I was duly given a Competency Assessment Result Summary (CARS) for my Drving NC2; 2. That on December 2020, I discovered that the said CARS was misplaced and eventually got lost in our house; @ . That despite diligent effort to recover the said CARS, | could no longer recover it, such that I believe it is now lost beyond recovery; 4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and for whatever legal purposes it may serve. IN WITNESS WHEREOF, I have hereunto set my hand this July 9, 2021 at Cabadbaran City, Agusan del Norte, Philippines. anu YATAN Affiant. SUBSCRIBED AND SWORN to before me, a Notary Public in the City of Cabadbaran, Agusan del Norte, this July 9, 2021, by the Affiant who presented the foregoing competent evidence of identity. Doc No, (081 Page No. 110 Book No. XV Series of 2021.Republic of the Philippines O wr Department of Labor and Employment TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY TRAINERS METHODOLOGY CERTIFICATE I is awarded to JOSEPH S. YATAN 1 having completed the competency requirements under the Philippine TVET Trainers ig Qualification System (PTTQS) in the following units of competency syst ipel CODE BASIC COMPETENCIES cone CORE COMPETENCIES 50031110 Plan training sessions 00282101 Fecltate leaming sessions ing ‘Supervise Wor-based leaming 100232102 Apply environmental principles and Conduct competency ‘advocate conservation Maintain training facies 00232103 Ube IT applications in echnical ning ‘Ulize electronic mean facitating training 500311110 Lead small teams SO122104 Aoi wa ais, vale nut pes 500232105 Work efectvly in vocational eduction ar training 1500232106 Foster and promote aleaming cure 1500232107 Ensue healthy and safe leaming envenment 500232108 Maintan and enhance profesional practice 500232109 Develop and promote appreciaton for cost benef of technical training surazt0 Dvn and roel ba uerstnng of Certificate No. TMC - 1433010100045 Issued on: October 16, 2014 Valid Until: October 16, 2019 Signature of the Holdei SEC. EMM. iL JOEL J. VILLANUEVA ‘ector General 9 CLN-MC - 3301000145Republic of the Philippines Department of Labor and Employment ‘TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY This certifies that JOSEPH S. YATAN has successfully completed the requirements under the Philippine TVET Trainers Qualification System (PTTQS) for NATIONAL TVET TRAINER CERTIFICATE LEVEL | in AUTOMOTIVE SERVICING NC II Certificate No. _120833051221196_ Issued on; _ December 20, 2012 SEC. EMMANUEL JOEL J. VILLANUEVA Director General CLN-NTTC- 000002-00156 - 21221Republic of the Phippines CARAGA STATE UNIVERSITY (163 85) 818583 CABADRARAN CITY CAMPUS. URL ip/esue cased gh Cro Stet, Caboderan Cy 905, Agusan cel Nate tal dees uci @amal om € 1 Competence Service Uprightness HUMAN RESOURCE MANAGEMENT SERVICES CERTIFICATE OF EMPLOYMENT To whom it may concern: This is to certify that MR. JOSEPH S. YATAN is a bona fide employee of the Caraga State University Cabadbaran City since June 01, 2015 up to the present with an academic rank of Assistant Professor IV. This is to further certify that Mr. Yatan is handling Automotive Technology subjects such as light vehicle driving, automotive servicing, engine overhauling, and automotive diagnostic system. This certification is issued upon request of Mr. Yatan for whatever purpose this may serve him best. Given this 7" day of July, 2021 at Caraga State University Cabadbaran City, ‘Agusan del Norte, Philippines. ROXAN M. IXUSTRISIMO Administrative Officer IVRepublic of the Philippines Department of Labor and Employment y ( ‘TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY NATIONAL CERTIFICATE 1! AUTOMOTIVE SERVICING * is awarded to JOSEPH S. YATAN for having completed the competency requirements under the Philippine TVET Competency Assessment and Certification System in the following units of competency: 17723006 Proce Shp Safety Procedres ‘ALTSH1207 Inspect Techical uty of Work ‘ALT3S1208 Mottin Qual Sette ALT311209 Provide Werk Sif stuns ALT723210 enya Select Orga Atonove Pas and Products CODENO. CORE-COWPETENGES A729 Pere Dsl Eng Tie Up ‘ALT723302 Perform Gas Engine Tune Up © ALT?2154 Renove end Rel Elector UniAsantn ALTT255 Reve end To Ege Sale Carport ALT72399 Remove sd Tag Aerob Song, Sispenien apd Se Spe congeners ALTT2x57 Renova nd Top Teenie Stem Carports Signature of the cértificate holder Issued on ; July 24, 2015 Certificate No. 15330301002480 Valid until: July 23, 2020 By SEC. ff JOEL J, VILLANUEVA = Director General lie: Bs CLN-NQ- 0104855rear Republic of the Philippines Department of Labor and Employment ‘TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY _ NATIONAL CERTIFICATE 1! AUTOMOTIVE SERVICING * is awarded to JOSEPH S. YATAN 1 having completed the competency requirements under the Philippine T Competency Assessment and Certification System in the following units of competericy: (CODENO. BASIC COMPETENCES Received and Respro Werpace Commicaton Work wih Oters Demonstrate Work Veins Iesrctons Pree Base Housakoopng Procodures ‘cently an Slot Oral Autorc ve Parts and Pros (CORE COMPETENCES Peco Diss Enine Tune Up Perm Gas Engine Te Up = Remove and Replace ElctclElectorc Unsere Remove and Tg Engine Sytem Components Remove and Tag Auomotve Stoing,Suspondon ard Signature of the eértificate holder Certificate No. 15330301002480Republic ofthe Philippines CARAGA STATE UNIVERSITY ssasaesss GS CABADBARAN CITY CAMPUS URL hita/fesucccarsueduph = SR |. Curato Street, Cabacbaran City 8605, Agusan del Norte Email Address: csuccofficial@gmailcom as a Competence Service Uprightness HUMAN RESOURCE MANAGEMENT SERVICES CERTIFICATE OF EMPLOYMENT To whom it may concern: This is to certify that MR. JOSEPH S. YATAN is a bona fide employee of the Caraga State University Cabadbaran City since June 01, 2015 up to the present with an academic rank of Assistant Professor IV. This is to further certify that Mr. Yatan is handling Automotive Technology subjects such as light vehicle driving, automotive servicing, engine overhauling, and automotive diagnostic system. This certification is issued upon request of Mr. Yatan for whatever purpose this may serve him best. Given this 7” day of July, 2021 at Caraga State University Cabadbaran City, Agusan del Norte, Philippines.Republic of the Philippines , Y Department of Labor and Employment q f ‘TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY NATIONAL CERTIFICATE AUTOMOTIVE SERVICING * is awarded to JOSEPH S. YATAN for having completed the competency requirements under the Philippine TVET Competency Assessment and Certification System in the following units of competericy: . (CODE NO, BASIC COMPETENCIES 00311105. Pacatn Worplace Conmanictn 500311106 Werkin Team Endrcnent SOISTTI07 racic Career Profesional 500511106 Pracioe Ganpatona Heth and Safety Procedures ‘COMMON COMPETENCIES ‘py Bopp Sealrtesve Move and Posten Vetide Perla Mensraton and Cleston Read, erpretand Apply Spctlcatns end Manual Use nd App Libcarts!Colnts Param Shop Maitonenoe Pero Jb Estas IntpretDrew Tectncal Dring Practes Heath, Sele and Enionent Proce ACTS1Q07 —lnpec Tefal Quy of Work NT311208 Manian Guality Syste Signature of the certificdte holder Issued on ; August 26, 2015 Certificate No. 1533030202831 Valid until. August 25,2020 IRE) sec. EMMANOPL JOEL J. VILLANUEV, ielite: Director Generally 2 CLN-NQ- 0104856Repetto: TO-R0S = DEPARTMENT OF HEALTH ‘CABADBARAN DIAGNOSTIC CENTER F, MORA STREET, TOLOSA, CITY OF CABADBARAN, AGUSAN DEL NORTE Phone Number (086)816-5532 DRUG TEST REPORT SN031875 i 58 GCF No: 202107130006 ‘Transaction Date Time: 7/19/2021 11:01:00AM Name: YATAN, JOSEPH SUAZO Repont Date Time: T3201 11:10:51 Birthdate: 03/18/1975 Ager: 48 Gonder: M Test Method = TESTKIT Requesting Parties Purpose Others OTHERS Result ‘Drug/Metabotto Result [Remarks METHAMPHETAMINE NEGATIVE TTETRAHYDROCANNABINOL NEGATIVE Test Conducted By a, 55 CHRISTOP ELINOROSARIO SEC oR por BACALSO ATUPAN 65 5 ead of Laboratory Valid thin 42 me action Date This fs a DOH-DDB IDTOMIS generated reportRepublic of the Philippines NATIONAL POLICE COMMISSION PHILIPPINE NATIONAL POLICE Camp BGen Rafael T Crame, Quezon City NATIONAL POLICE CLEARANCE ‘THIS 1S TO CERTIFY thet he person hoo name, shat, signature end rant mumbmark appear herein, has undergone roksan kenealion and verfeabon of ‘he Crime Related Record td denifeaton of Naonal Police Cearance System. NAME ‘YATAN, JOSEPH SUAZO [ADDRESS _: 210 FUNCION POBLACION S\CABADBARAN CITY AGUSAN DEL NORTE BIRTHDATE. March 18,1975, BIRTHPLACE. TALISAYAN, MISAMIS ORIENTAL CITIZENSHIP. FILIPINO GENDER | MALE NO RECORD ON FILE DATE 1SSUED: duly 10,2021, \VALIO UNTIL: January 10,2022 By EASE ae a PMGEN ApAEL B ESCOBAL ‘aR cove TOIOM NOTE: To very tne aon of thie Police Clearance, lenge vk 1D No.-TRARLO20210709004930 Inipipnplearance i ore GR. code sanner Republic of the Philippines NATIONAL POLICE COMMISSION PHILIPPINE NATIONAL POLICE ‘Camp BGen Rafael T Crame, Quezon City NATIONAL POLICE CLEARANCE Tis 18 TO CERTIFY mat the preon wien name, polo, sanatre and ‘ight burbmark appear horn has undergone rouiaryieniicaton and vere of ‘he Come-Reatd Records a derision of Nana Pace Ciesrance Syston Nae, YYATAW, JOSEPH SUAZO [ADDRESS _; Z10FUNCION POBLACION 3 CABADBARAN CITY AGUSAN DEL NORTE BIRTH OATE March 18,1875 BIRTHPLACE. TALISAYAN, MISAMIS ORIENTAL CITIZENSHIP FILIPINO, ceENDER =| MALE DOATE ISSUED: July 10,2021 VAUD UNTIL: January 10,2022 ~~ NO RECORD ON FILE PMGEN ARAEL B ESCOBAL ‘TOIOM Ald NO GHYOO03Y ON NOTE: Te very the then of thie Poles Clearance lease Vt 1D No:TRARLO20210709004930 tpevipnplearance pt or use OR. code ssanner dla NO GYO93Y ONRepublic of the Philippines Rate, Department of Labor and Employment NATIONAL CERTIFICATE 1 rs in AUTOMOTIVE SERVICING ° is awarded to JOSEPH S. YATAN for having completed the competency requirements under the Philippine TVET Competency Assessment and Certification System in the following units of competericy: . ania AS11208 Signature of thé @mpficate holder Issued on ; August 26, 2015 Certificate No. 1330302002831 Valid until: August 25, 2020 CEKIIFIED TKUE COPS ORIGINAL. Cuato Stet, Cabacbaran City 8605, Agusan del Note mal Aderess:csucoffial@gmallcom . Republic of the Philippines CARAGA STATE UNIVERSITY (+6385) 8185583 © ‘ABADBARAN CITY CAMPUS ‘URL: http//esucc.carsu.edu.ph Competence Service Uprightness HUMAN RESOURCE MANAGEMENT SER VICES CERTIFICATE OF EMPLOYMENT To whom it may concern: This is to certify that MR. JOSEPH S. YATAN is a bona fide employee of the Caraga State University Cabadbaran City since June 01, 2015 up to the present with an academic rank of Assistant Professor IV. This is to further certify that Mr. Yatan is handling Automotive Technology subjects such as light vehicle driving, automotive servicing, engine overhauling, and automotive diagnostic system. This certification is issued upon request of Mr. Yatan for whatever purpose this may serve him best. Given this 7" day of July, 2021 at Caraga State University Cabadbaran City, Agusan del Norte, Philippines. ROXAN M. slisrecis Administrative Officer IVee @ e@ 6.0 @€ 6 ©. 0@ 8 @ 6-0 ‘ Republic ofthe Philipines 5 10-12027210450060] DEPARTMENT OF TRANSPORTATION LAND TRANSPORTATION OFFICE, East Avenue, Quezon City Field Office:-Catadbaran District Office _ rigid Office Code: 1510 GURNEE 2104500602 oare,_mascon ECEIVED FROM (Lastname, Firstname, Ml) Ay YATAN, JOSEPH SUAZO ARPBREE Ar Stax, Gia Meare eee Be Rede TOTAL AMOUNT PAID THESUMOF (PHL Hundred Shy Seven And 63/100 Pe TASH eeee#e-e#2@0e88e-0@@8@ 80 0:8OFFICIAL RECEIPT Republic of the Philippines = SARAGA STATE UNIVERSITY Cabadbaran Campus Cabadbaran City, Agusan Del Norte Rertedjanagrie (N° 0113374 113374 DNREO7, 2027 Payor Fu; RIP (Conneeinet GERCEET:crion | ACCOUNT) AMOUNT 0.00 a TOTAL i Pe Aveparant Pesos ohly a) Saar O cash BANK ae _= O check [Money Order Received the amount sated above NOTE: Write the number and date of thi-feceipt on the back of check or money order received,