NAME MAY ANN MATUGAS COSTALES

ADDRESS BLK 23 Lot Gillian Hills Llamo RD. Caloocan

City
OR SALES INVOICE
CR [Category]
MAKE MITSUBISHI XPANDER
MOTOR 1NRX969501
CHASSIS PA1B18F37P4200404
PLATE Z2C312
YEAR 2023
ID UMID 0111-2122778-7
PHONE 09051726143
EMAIL MADELMROQUE@GMAIL.COM
BANK SECURITY BAN
 REPUBLIC OF THE PHILIPPINES
QUEZON CITY_______________) S.S.

Affidavit of Undertaking

I, (name of applicant) ___MAY ANN MATUGAS COSTALES___, of legal age, married/single, Filipino and
residing at (address) ____BLK 23 Lot Gillian Hills Llamo RD. Caloocan City_______after being sworn to in
accordance with law, hereby states that;

I am the absolute holder of Official Receipt No. ______________

SALES INVOICE and Certificate of Registration
No._________________ which are described as follows:

MAKE MOTOR NO. CHASSIS NO. PLATE NO. YEAR MODEL

MITSUBISHI 1NRX969501 PA1B18F37P4200404 Z2C312 2023
XPANDER
x-----nothing follows-----x

That I acquired the subject motor vehicle through financing means with chattel mortgage from (financing
company)_________SECURITY BAN_________.

That the original copy of the certificate of registration and official receipt of the subject motor vehicle is under the
possession of (financing company) _________SECURITY BAN__________.

That as a documentary requirement in the Application for New Certificate of Public Convenience to operate a
TNVS as a subject of a motor vehicle, I undertake to preserve and present the document (certificate of
conformity) during hearing/formal offer of evidence before the Board for conformity.

That I further sworn, that if the certification is found spurious, I shall be solely liable for any punitive
consequence/s and, the LAND TRANSPORTATION FRANCHISING REGULATORY BOARD Chief/Head of
Office/employees shall be freed from any liability, criminal or administrative hereof, and;

That I am executing this affidavit of undertaking to attest the truth and veracity of the fact/s stated above, and
affirm my undertaking given herein compliance with LTFRB Board Resolution No. 185 Series of 2022 amended
Memorandum Circular no.: 2018-005.

IN WITNESS WHEREOF, I was hereunto set our hand this ____ day of _______________ 2023 at
Quezon City, Philippines.

MAY _______
ANN MATUGAS COSTALES
_______________
Applicant

SUBSCRIBED AND SWORN TO before me this ___ day of ___________ at Quezon City, Affiant
exhibited to me his valid ____UMID 0111-____issued at______on_______.
_________
2122778-7

Doc. No. ____

Page No. ____
Book No. ____
Series of. 2023
 SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

That I, __MAY ANN MATUGAS COSTALES__ Filipino and residing _BLK 23 Lot Gillian Hills Llamo RD.
Caloocan City_________ do hereby NAME APPOINT AND CONSTITUTE ATTY. ANANIAS V.
BIRAD JR. , who is likewise of legal age, Filipino postal address 28 B MAKISIG ST.
DILIMAN QUEZON CITY to be the true and lawful ATTORNEY IN-FACT for me my name and
stand, to do perform the following acts, to wit;

1. To file and process, sign and execute, application, affidavit and my other documents
whatsoever in connection where to in the LTFRB and TNC company such as JOYRIDE.
2. To receive orders, Notices of hearing, plate numbers, stickers, or any other documents from
Land Transportation Franchising Regulatory Board;
3. To represents, testify, answer, and enter into compromise in any hearing or investigation
conducted by the Land Transportation Franchising Regulatory Board.

HEREBY GRANTING unto my representative full power and authority to execute and perform
every act necessary to render effective the power above-mentioned, as though I myself, have performed
it, and HEREBY APPROVING ALL that he/she may do by virtue hereof with full right of substitution
of his/her person and revocation of this instrument.

IN WITNESS WHEREOF, I have hereunto set my hands this ____ day of __________2023, in
Quezon City.

________________________
MAY ANN MATUGAS COSTALES ___ ATTY. ANANIAS V. BIRAD JR.__
Principal Attorney-in-fact

REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S.

Before me, a Notary Public for and in the Municipality of Quezon City, personally appeared the
principal, known to me and to be the same person who executed the foregoing instrument, and
knowledge that he executed the same as his/her free act and deed.
Quezon City, this ___ day of ___________2023.

Doc. No.:
Book No.:
Page No.:
Series of 2023
 DEPARTMENT OF TRANSPORTATION
Land Transportation Franchising and Regulatory Board
East Ave., Quezon City

SWORN UNDERTAKING

I, ___MAY ANN MATUGAS COSTALES____ of legal of age, Filipino, operatorof

(__________TNVS______________) and/or duly authorized representative of
(______JOYRIDE_______), after having been sworn in accordance with law,
hereby declare that:

1. I am the applicant and/or grantee of a Certificate of Public Convenience (CPC) to operate

___TNVS________ Service docketed under Case No. __________;

2. The unit proposed to be authorized in the said Application/CPC to operate __________ is a motor
vehicle lease from _________________SECURITY BAN________________________ as the Lessor,
under Lease Contract/ Agreement, which is more particularly described hereunder:

MAKE MOTOR NO. CHASSIS NO. PLATE NO. YEAR MODEL

MITSUBISHI 1NRX969501 PA1B18F37P4200404 Z2C312 2023
XPANDER
3. That being the Lessee of the above described unit, I Under take to do and perform the following
act:
a. To secure necessary government clearances/permits to legally operate transportation business;
b. To pay all expenses such as but not limited to financing costs, taxes and
licenses and for any procedures, such as but not limited to securing
government requirements for roadworthiness and road safety in making the unit legally
operational;
c. To submit Official Receipt (OR) and Certificate of Registration (CR) of the
above described unit indicating the name of the Lessor and name of the
Lessee;
d. Ensure that the above described motor vehicle shall not be used nor shall allow the said unit to
be used for any illegal purpose.

4. Being the Lessee of the above leased motor vehicle, I further Undertake to assume
full responsibility for any and all obligations and damages that may be incurred in
the event of any untoward incident involving the unit being applied for CPC, and/or
in case of violation of any government laws, policies, rules and regulations and shall
indemnify the Lessor, its employees and agents and render them harmless from any
and all claims, actions, suits, proceeding costs, expenses, damages and liabilities,
including attorney’s fees arising from any untoward incident involving the above described unit;

5. I execute the affidavit to confirm the truth of the foregoing.

IN WITNESS WHEREOF, I have here unto set my hand, this __ day of_____________________,
2023 at ______________________.

MAY ANN MATUGAS COSTALES

______________________________
Affiant

Subscribed and sworn to before me this ___ day of ____________ 2023 with___________________
UMID 0111-
issued on ________________ at ________________.
2122778-7
Notary Public

Doc. No.
Page No.
Book No.
Series of 2023

REPUBLIC OF THE PHILIPPINES

 QUEZON CITY_______________) S.S.

Affidavit of Undertaking

I, (name of applicant) MAY ANN MATUGAS COSTALES, married/single, Filipino and residing at
(address) BLK 23 Lot Gillian Hills Llamo RD. Caloocan City after being sworn to in accordance with
law, hereby states that;

I am the absolute holder of Official Receipt No. SALES INVOICE and Certificate of Registration No.
[Category] which are described as follows:

MAKE MOTOR NO. CHASSIS NO. PLATE NO. YEAR MODEL

MITSUBISHI 1NRX969501 PA1B18F37P4200404 Z2C312 2023
XPANDER
x-----nothing follows-----x

That I acquired the subject motor vehicle through CASH.

That the original copy of the certificate of registration and official receipt of the subject motor vehicle is under my
possession.

That as a documentary requirement in the Application for New Certificate of Public Convenience to operate a
TNVS as a subject of a motor vehicle, I undertake to preserve and present document such as original OR/CR
during hearing/formal offer of evidence before the Board for conformity.

That I further sworn, that if the certification is found spurious, I shall be solely liable for any punitive
consequence/s and, the LAND TRANSPORTATION FRANCHISING REGULATORY BOARD Chief/Head of
Office/employees shall be freed from any liability, criminal or administrative hereof, and;

That I am executing this affidavit of undertaking to attest the truth and veracity of the fact/s stated above, and
affirm my undertaking given herein compliance with LTFRB Board Resolution No. 185 Series of 2022 amended
Memorandum Circular no.: 2018-005.

IN WITNESS WHEREOF, I was hereunto set our hand this ____ day of _______________ 2023 at
Quezon City, Philippines.

MAY ANN MATUGAS COSTALES

Applicant

SUBSCRIBED AND SWORN TO before me this ___ day of ___________ at Quezon City, Affiant
exhibited to me his valid _________________issued
UMID 0111-2122778-7 at______on_______.

Doc. No. ____

Page No. ____
Book No. ____
Series of. 2023

Form No. 012: with hearing

Revised as of 5/10/2021

REPUBLIC OF THE PHILIPPINES

Department of Transportation
LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
East Avenue, Quezon City
MAY ANN MATUGAS COSTALES, CASE NO.
Applicant.

Application for a Certificate of Public

Convenience to Operate a TRANSPORT
NETWORK VEHICLE SERVICE
x-----------------------------------------------x

APPLICATION FOR
CERTIFICATE OF PUBLIC CONVENIENCE
WITH PRAYER FOR ISSUANCE OF PROVISIONAL AUTHORITY

Applicant, most respectfully request for the issuance of a Certificate of a Public Convenience
(CPC) to operate a Transport Network Vehicle Service (TNVS), and in support thereof, states that:

1. Applicant is a Filipino citizen and may be served with legal processes at BLK 23 Lot Gillian Hills
Llamo RD. Caloocan City email address: MADELMROQUE@GMAIL.COM@gmail.com and
contact details 09051726143

2. Applicant applies for a TNVS CPC for the transportation of passenger and freight within METRO
MANILA which includes MUCEP area, accessible to motor vehicle traffic and vice versa, with
the use of (1) unit, to wit:

PLATE /
MAKE MOTOR NO. CHASSIS NO. MODEL
COND NO.
MITSUBISHI
1NRX969501 PA1B18F37P4200404 Z2C312 2023
XPANDER
X- Nothing Follows –X

3. 9Applicant is financially capable to operate as a TNVS.

4. Applicant will comply with all the requirements of this honorable board and will abide with the
existing LTFRB rules and regulations, the public service act, and other pertinent / policies.

5. Applicant has completed / currently completed all the documentary requirements for the
Application, copies of which are hereto attached in Annexes.

6. With the consideration and approval of this Application, public necessity and convenience will be
promoted in a suitable manner.

PRAYER

WHEREFORE, it is most respectfully prayed that (a) a Notice of Hearing be issued, (b) this
Application for a Certificate of Public Convenience to Operate a TNVS be accepted, considered and
approved; and (c) in the meantime, a Provisional Authority be issued in Applicant’s favor.

Other reliefs just and equitable under the premises are likewise prayed for.

Quezon City, Metro Manila, ____________________

 MAY ANN MATUGAS COSTALES
Applicant

WAIVER

I MAY ANN MATUGAS COSTALES hereby grant authority to LTFRB, to verify the
authenticity of all documents herein submitted together with this application from both government and
private sources.

MAY ANN MATUGAS COSTALES

Applicant

VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING

I MAY ANN MATUGAS COSTALES ,Filipino and with business address after a processes BLK 23
Lot Gillian Hills Llamo RD. Caloocan City having been duly sworn to in accordance with law hereby
depose and say that:

1. I am the applicant in the above-entitled case;

2. I have caused the preparation of the forgoing application;
3. I have read the contents thereof and the same are true to the best of my knowledge and belief on
the basis of the information and documents provided to me by the applicant;
4. To the best of my knowledge, I have not commended any other action or proceeding involving the
same issue in any other LTFRB office;
5. To the best of my knowledge, no such other application, petition or pleading is pending therein,
and if I learn of the same or similar application, petition, or pleading has been filed or is pending, I
shall report of such fact within five (5) days there from to the honorable board.

MAY ANN MATUGAS COSTALES

Applicant

SUBSCRIBED AND SWORN to before me this 9th day of January at QUEZON CITY, Affiant
exhibited to me his UMID 0111-2122778-7 issued at Quezon City on ___________________________.

Doc. No.: _______________

Book No.: _______________
Page No.: _______________
Series of 2023.
CASE NO.

APPLICATION
FOR NEW CPC
WITH PRAYER FOR
ISSUANCE OF
PROVISIONAL
AUTHORITY

MAY ANN MATUGAS COSTALES

Applicant