FORM NO.

7: REAL PARTIES-IN-INTEREST

REPUBLIC OF THE PHILIPPINES)

CITY OF IMUS ) S.S.

AFFIDAVIT OF INSURANCE CLAIMS

I, Miranda Curl, of legal age, Filipino, married, and presently residing at Blk 55, Lot 66, Ibarra
Homes, Tulingan, Cavite, after having been duly sworn to in accordance with law, depose and state:

1. I am the owner of a certain registered motor vehicle, which I inherited from my deceased
father through intestate succession, with the particular description as follows, to wit:

MAKE: Honda

BODY: Sedan SERIES:

Civic MODEL: 1998

PLATE NO.: UTS 101

Serial/Chassis No.: US15- 2B3509

MV FILE No.: 2477- 33438

2. On 03 October 2013 at 2 o’clock in the afternoon, the said motor vehicle met an accident.

3. This had happened while i was parking in front of a hardware store between the two motor
vehicles, at the left side was an elf van, and while at the right was a car. At that time, I was
carefully looking at the car on my right, that I did not notice the elf van in the parking area.
When I made a reverse turn, i hit the elf by my tail light and bumper

4. It is for that reason that i am executing this affidavit to file a claim for insurance.

5. I therefore have executed this Affidavit to attest the truth I mentioned herein and for
whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day of January 2014 in Imus City,
Cavite, Philippines.

MIRANDA CURL
Affiant
Philippine Passport No. 123456
valid until January 13, 2018

SUBCRIBED AND SWORN TO before me this 30th day of January 2014 in Imus City, Cavite,
Philippines, affiant exhibiting to me her competent evidence of identity indicated below his above- stated
name.

Doc. No. _____;

 Page No. _____;

Book No. _____;

Series of 2014.

FORM NO. 8: REPRESENTATIVE PARTIES

REPUBLIC OF THE PHILIPPINES)

CITY OF IMUS ) S.S.

AFFIDAVIT OF PARENTAL CONSENT TO MARRIAGE

WE, KENDALL RUNNER and RON JEREMY, both of legal age, Filipinos, husband and wife,
respectively, and presently residing at Blk 55, Lot 66, Ibarra Homes, Tulingan, Cavite, after having been
duly sworn to in accordance with law, depose and state:

1. I am/we are the parents of Rocco Siffredi born in born on 18 October 1998 in Grace Park,
Caloocan City

2. My/Our child is intending to contract marriage with Nana Oguya in Meycauayan, Bulacan;

3. I we are giving our consent to our child, Rocco Siffredi, marrying said Nana Oguya;

4. We are executing this Affidavit for the purpose of informing the authorities concerned of the
veracity of the foregoing facts and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this 27th day of January, 2014 in Imus
City, Cavite, Philippines.

KENDALL RUNNER

Affiant (Mother)

RON JEREMY

Affiant (Father)

SUBCRIBED AND SWORN TO before me this 30th day of January 2014 in Imus City, Cavite,
Philippines, affiant exhibiting to me her Philippine Passport No. 123456 issued in Manila on January 12,
2014 and valid until January 13, 2018.

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2014.
FORM NO. 9: STOCKHOLDER SUING IN A DERIVATIVE SUIT

Juan de Bagyo and Perdo Pobre

and ABC Corporation, the former
suing as representative of said corporation,
and other stockholders,

Plaintiffs,

-versus- Civil Case No. ____

Derivative suit

Jose Gabiano, Ricardo Tria, Rumolo

Castillo, Jay Padilla

Defendants.

x---------------------------------------x

Allegations showing requirements of derivative suits:

Plaintiffs Juan de Bagyo and Pedro Pobre, both of legal age, are minority stockholders of plaintiff
ABC Corporation, a corporation duly-organized and existing under and by virtue of the laws of the
Philippines, with principal offices at 532 Ayala Ave., Makati City, and are suing in this derivative suit in the
name and as representatives of said corporation.

Defendants are members of the board of directors of said corporation, who in breach of trust,
committed acts inimical to the interests of the corporation, namely: allege facts showing violations of Sec.
31 of the Corporate Code, to the damage and prejudice of the corporation.

Allege other requirements of derivative suit, as prescribed in Rule 8 of the Interim Rules of
Procedure for Intra-Corporate controversies, such as that plaintiffs exerted all reasonable efforts,
particularly describing such efforts, to exhaust all remedies available under the articles of incorporation,
by-laws or rules governing the corporation to obtain relief they desire; that no appraisal rights nuisance
or harassment suit.

Etc.