REPUBLIC OF THE PHILIPPINES

Province of Negros Occidental)S.S.

City of Bacolod )

AFFIDAVIT

I, LOURDES T. AGUDON, of legal age, widow and a resident of Brgy. Capt. Ramon, Silay
City, Negros Occidental, after having been duly sworn to in accordance with law, do hereby
depose and state the following:

1. That I am the owner/operator of a PASSENGER JEEPNEY;

2. That I hired the services of LEOPOLDO AGUDON, DANNY AGUDON, JIMEL AGUDON
and ANTHONY ALARCON as my drivers for the said jeepney on January of 2000;

3. That I also hired the services of JENNIFER FLORES as helper on January of 2000 until
2010;

4. That LEOPOLDO AGUDON, DANNY AGUDON and ANTHONY ALARCON drove my

passenger jeepney on a percentage basis;

5. That they voluntary agreed that the percentage rate for which they will be paid was
fixed at Thirty Five Percent (35%) of the amount collected per trip;

6. That from January to March 2010, LEOPOLDO AGUDON, DANNY AGUDON, JIMEL
AGUDON, ANTHONY ALARCON and JENNIFER FLORES were still my employees and
by reason of which SSS contribution were remitted accordingly;

7. That from April to June 2010, LEOPOLDO AGUDON, JIMEL AGUDON, ANTHONY
ALARCON and JENNIFER FLORES were still under my employ to which SSS
contributions were remitted accordingly, except DANNY AGUDON who informed me
of his desire to terminate his services by reason of his employment with another
operator;

8. That from July to September 2010, monthly contributions were remitted for
LEOPOLDO AGUDON, JIMEL AGUDON and ANTHONY ALARCON;

9. That JENNIFER FLORES was not already under my employ effective July 2010, hence
the non-remittance of monthly SSS contributions;

10. That JIMMEL AGUDON was not already under my employ effective October 2010,
hence the non-remittance of monthly SSS contributions;
 11. That from January to December 2011, ANTHONY ALARCON and LEOPOLDO AGUDON
were still under my employ but due to inadvertence, only the monthly contributions
for October to December 2011 were paid;
12. That on January 2012, ANTHONY ALARCON and LEOPOLDO AGUDON ceased to be
my employees after they manifested their intention to severe their employment ties
for reasons beyond me;

13. That on January 2012 up to the present, I hired the services of my son RODOLFO P.
AGUDON as the sole driver of my passenger jeepney;

14. That from 2012-2016, my son RODOLOFO P. AGUDON was working as a part-time
driver only as he was still employed as security guard in Bacolod City;

15. That from November of 2016 up to the present, my son RODOLFO P. AGUDON is
driving my passenger jeepney as a full-time driver, by reason of his retirement from
the aforementioned previous employment.

16. That I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purposes that his statement may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this _____________________, in

the City of Bacolod, Philippines.

LOURDES T. AGUDON
AFFIANT

WITNESSED BY:

___________________________ __________________________
ANTHONY ALARCON LEOPOLDO AGUDON

___________________________ __________________________
DANNY AGUDON RODOLFO AGUDON

SUBSCRIBED AND SWORN to before me, this __________________________, by

LOURDES P. AGUDON who exhibited to me her Social Security System ID No. 07-0858763-4
issued at Bacolod City, Philippines.

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