Republic of the Philippines)
Paranaque City )S.S.
JOINT AFFIDAVIT OF ONE AND THE SAME PERSON
(RE: One and the Same Person)
We, REANDEL JOHN NACARIO TOMAS and CHRISTOPHER ROMERO MARATAS
JR., both of legal age, Filipinos, and resident of RM 217 2nd Floor Blanco Arms Bldg., 2424
Zamora St., Brgy. 107, Pasay City and 50 Countryside Barangka Ibaba, Mandaluyong City, after
having been duly sworn in accordance with law, do hereby depose and say:
1. That we personally know, WINNONA BROOC SHEN JAVIER who has no
middle name, who is our long time neighbor in Paranaque City;
2. That her name, WINNONA BROOC SHEN JAVIER who has no middle name, is
also appearing in his Certificate of Live Birth issued by Local Civil Registry of San
Villanueva, Misamis Oriental;
3. That the said name is also appearing in his PhilHealth ID no. 15-253309796-5
issued by PhilHealth
4. However, in the Social Security System (SSS) Records, her name was
erroneously recorded as WINNONA BROOC SHEN JAVIER JAVIER, that the
said discrepancy was made due to wrong entry of her name when registering at
Social Security System (SSS);
5. That to remove confusion, we hereby attest that the name, WINNONA BROOC
SHEN JAVIER, that is appearing in her Certificate of Live Birth and PhilHealth ID
no. 15-253309796-5 issued by PhilHealth and the name, WINNONA BROOC
SHEN JAVIER JAVIER, as appearing in the Social Security System (SSS)
Records, is referring to one and the same person and WINNONA BROOC SHEN
JAVIER is his true and accurate name;
6. That I am executing this affidavit to attest to the foregoing facts for all legal
intents this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of August 2025 in
Paranaque City, Philippines.
REANDEL JOHN NACARIO TOMAS and CHRISTOPHER ROMERO MARATAS JR
Affiants
SUBSCRIBED AND SWORN to before me this 13 th day of August 2025 in Paranaque
City, Philippines, affiant exhibiting to me their proof of identification: National ID – 2038-4634-
2198-3713 & UMID – CRN-0111-7727438-6.
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Book No.
Series of 2025
Republic of the Philippines)
Paranaque City )S.S.
AFFIDAVIT OF LOSS
I, ELISEO JAMIG LEPON JR., of legal age, Filipino, and resident of 29 Fame St.,
Fourth Estate Area 2, Kinawahan, San Remigio, Cebu, after having been duly sworn in
accordance with law, do hereby depose and say:
1. That I am the owner of the Student Permit, PDC and DDC issued under my
name by Land Transportation Office (LTO);
2. That on May 2024, the said Student Permit, PDC and DDC was lost presumably
it was thrown out while I was cleaning my room without noticing it;
3. That despite of diligent search and effort was exerted to locate the said Student
Permit, PDC and DDC, It could no longer be found and was marked as lost;
4. That I am executing this affidavit to attest to the foregoing facts for all legal
intents this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 13 th day of August 2025 in
Paranaque City, Philippines.
ELISEO JAMIG LEPON JR.
Affiant
SUBSCRIBED AND SWORN to before me this 13th day of August 2025 in Paranaque
City, Philippines, affiant exhibiting to me his proof of identification: Driver’s License – N64-22-
301496.
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Book No.
Series of 2025
Republic of the Philippines)
Paranaque City )S.S.
AFFIDAVIT OF ACCIDENT
I, RAUL JR. FONTELLAR ARNAU, of legal age, Filipino, and resident of Annex 31
Better Living Subd., B7 L12, Paranaque CIty, after having been duly sworn in accordance with
law, do hereby depose and say:
1. That I am the driver/owner of the motor vehicle encumbered at Toyota Financial
Services Philippines Corporation, more particularly described as follows:
PLATE NO. NNHS3098 MAKE/BRAND TOYOTA
ENGINE NO. 1NRY277382 BODY TYPE SEDAN
CHASSIS NO. PA1B18F3XR4262219 SERIES VIOS 1.3 XLE
CVT
FILE NO. 132424002364373 YEAR MODEL 2025
VEHICLE PASSENGER CAR COLOR SUPER RED V
TYPE
O.R. NO. 1324-000000525583 C.R. NO. 0021369663
2. That on April 7, 2025, around 4:00 in the afternoon, while I was driving at Taguig
City going to Pasig City, there was a big pot hole in the road, I was about to
dodge the said pot hole but I got panicked and accidentally hit the parked 2 E
Trike and a Halo Halo Vendor. Due to the said accident, the said motor vehicle
accumulated damages like dents, scratches and destroyed grill, bumper and
pender and was paid all the damages in the property in cash for the 2 E trike
amounting each Php 3, 000.00 and for the Halo Halo Vendor amounting to
approximately Php 10,000.000;
3. That I am executing this affidavit to attest to the foregoing fact that and to support
my application for the claiming of insurance of the motor vehicle and for all legal
intents this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day of August 2025 in
Paranaque City, Philippines.
RAUL JR. FONTELLAR ARNAU
Affiant
SUBSCRIBED AND SWORN to before me this 12th day of August 2025 in Paranaque
City, Philippines, affiant exhibiting to me his proof of identification: Driver’s License – N03-05-
019412.
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Book No.
Series of 2025
Republic of the Philippines)
Paranaque City )S.S.
AFFIDAVIT OF NON OPEARATION
I, ERIC TRINIDAD DELA CRUZ, of legal age, Filipino, and resident of 7 Yakal St.,
Severina Subd., Bagumbayan, Taguig City, after having been duly sworn in accordance with
law, do hereby depose and say:
1. That I am the owner of the business named MAXGALO BUKO SHAKE
STATION with business address at Jaka Plaza Dr. A Santos Ave., San Antonio,
Paranaque City;
2. That on June 18, 2025, due to bankruptcy, the said business was permanently
closed and ceased its operation;
3. That due to the said bankruptcy of the business, it gained no income and ceased
its entire operation;
4. That I am executing this affidavit to attest to the foregoing fact and to support my
application for the application of Business Closure of the said Business and for
all legal intents this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day of August 2025 in
Paranaque City, Philippines.
ERIC TRINIDAD DELA CRUZ
Affiant
SUBSCRIBED AND SWORN to before me this 12th day of August 2025 in Paranaque
City, Philippines, affiant exhibiting to me his proof of identification: NATIONAL ID – 5136-2941-
0798-5426;
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Series of 2025
