AFFIDAVIT OF DISCLOSURE OF NO RELATIONSHIP

I,
__________________________________,
of
legal
age,
__________________,
residing
at
_____________________________________________________________________
after being sworn in accordance with law, do hereby depose and say:
1. That
I
am
the
authorized
representative
of
the
________________________________ with the office address at
__________________________________________________.
2. That the firm/partnership/joint venture/corporation, or any of its
officers, directors, controlling stockholders and members, I
represent for the bidding of _________________________________, is
not related by consanguinity or affinity up to the third civil
degree to the head of the agency, to the BAC, TWG or
Secretariat members, or to any Procuring Entity official, who
directly took part in the bidding process.
3. That I am making this statement in compliance with Section 47
of the IRR-A of the R.A. 9184, and in accordance with the
requirements of the LGU Oton- BAC.
IN WITNESS WHEREOF, I have hereunto set my hand this
____________ day of _______________________, 200___, in the
_______________________, Philippines.

________________________
Affiant
SUBSCRIBED AND SWORN to before me this ______ day of
___________________, 200__ in the _______________________________,
Philippines.

_________________________
Notary Public

Doc. No. _________

Page No. ________
Book No. ________
Series of 200_____