Republic of the Philippines
Department of Transportation
LAND TRANSPORTATION FRANCHISING & REGULATORY BOARD
East Avenue, Quezon City
OPERATOR DATA SHEET
TYPE OF OWNERSHIP X Single Proprietorship Corporation
Partnership Cooperative
1. CASE NUMBER TNVS-2023-13122 NO. OF AUTHORIZED UNITS ONE (1)
TYPE OF SERVICE PUJ SB AUV
TH TX PUB_AC_REG
TTS SHS X TNVS
`
OTHER EXISTING FRANSHISES
CASE NUMBER TYPE OF SERVICE NO. OF AUTHORIZED UNITS GARAGE LOCATION
GARAGE ADDRESS WITH GARAGE DIMENSION
Direct Line 434-80-25 up to 36 Fax no. 921-2616
426-25-05, 426-25-01 426-2485
NO. OF UNITS PER GARAGE ONE
OWNED YES NO
LEASED YES NO
NAME OF LESSOR
II. FOR INDIVIDUAL OPERATOR:
LAST NAME GUTIERREZ
FIRST NAME JOY NALIE
MIDDLE NAME JUDIN
DATE OF BIRTH 10/07/1999 SEX: F M
TIN NO. 393-107-034-000
BUSINESS ADDRESS BLK 32 LOT 9 PH3 F1 BRGY. 12 DAGAT-DAGATAN CALOOCAN CITY
MAILING ADDRESS BLK 32 LOT 9 PH3 F1 BRGY. 12 DAGAT-DAGATAN CALOOCAN CITY
PHONE NUMBER 09212012477
EMAIL gutierrezw826@[Link]
SPECIMEN SIGNATURE
III. FOR CORPORATION/COOPERATIVE/OTHERS
NAME OF CORPORATION/COOPERATIVES/OTHER
SEC/CDA REGISTRATION NO. TIN NO.
BUSINESS ADDRESS
MAILING ADDRESS
PHONE NUMBER
EMAIL
IV. Authorized Representative [Note: Only the authorized representative identified in this sheet will be
allowed to transact business in the agency for and on behalf of the owner]
LAST NAME _
FIRST NAME
MIDDLE NAME
DATE OF BIRTH SEX: F M
TIN NO.
BUSINESS ADDRESS
MAILING ADDRESS
PHONE NUMBER
EMAIL
SPECIMEN SIGNATURE
V. Authorized Drivers
NAME ADDRESS Driver’s License Number Expiration Date
WILLIE AUSTRIA B36 L10 PH3 F1 SABALO ST. N04-03-493455 2032-09-26
GUTIERREZ DAGAT-DAGATAN BRGY.
12 CALOOCAN CITY
Operator undertakes that all information stated in this sheet are true and correct. Any misrepresentation and/or
unlawful withholding of information will warrant outright denial and/or cancellation of the franchise in accordance
with the Public Service Act. The Board reserves the right to VERIFY all information in this datasheet and to institute
appropriate criminal prosecution for any act prejudicial to the public interest.
ATTESTATION AND UNDERTAKING
I, JOY NALIE J. GUTIERREZ, do hereby ATTEST that the foregoing information are complete , true and
correct to the best of my knowledge and belief. I commit to inform the Board in writing any subsequent changes in this
data sheet within 15 days from knowledge thereof.
JOY NALIE J. GUTIERREZ
Signature over Printed Name
SUBSCRIBED AND SWORN TO before me this ________________________________, a notary Public for
and in the city of _____________________________________,the affiant showing to me his/her identification card
with no. TIN ID No. 393-107-034-000.
Doc No. : ____________
Page No. : ____________
Book No. : ____________
Series of : 2023