PhilGEPS Sworn Statement

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF PANGASINAN….)S.S
MUNICIPALITY OF MANGALDAN)

AFFIDAVIT

I, , of legal age, Filipino Citizen, and residing at Brgy. Anolid,

Mangaldan, Pangasinan, after having been duly sworn in accordance with law, do hereby and
depose and state that:

1. I am the authorized representative of , a sole proprietorship with office

address at ____________________of legal age, Filipino citizen and a resident of Brgy.
Anolid, Mangaldan, Pangasinan;

2. As the authorized representative of ___________________ as shown in the attached

SPECIAL POWER OF ATTORNEY, I have full power and authority to upload and
maintain in the Philippine Government Electronic Procurement System (PhilGEPS) a
current and updated file of the following Class “A” eligibility documents under Sections
23.1 (a) and 24.1 (a):

a.) Registration Certificate;

b.) Mayor’s/Business Permit or bits Equivalent Document;
c.)Tax Clearance;
d.)Philippine Contractors Accreditation Board (PCAB) license and registration (if
applicable); and
e.)Audited Financial Statements;

3. Each of the documents submitted is in satisfaction and compliance with the

requirements for PhilGEPS Platinum Membership and for participation in any Philippine
government bidding;

4. Each document is an authentic copy of the original, complete, and all statements and
information provided therein are true and correct;

5. I assume responsibility and full accountability on the validity and authenticity of the
documents submitted;

6. I am authorizing the PS-PhilGEPS and the authorized representative(s) of the

Procuring Entities to verify all the document submitted, if necessary; and

7. I am aware of and understood the following guidelines for the use of the Government
of the Philippines-Official Merchant Registry (GoP-OMR):

a. The PhilGEPS office shall not determine the eligibility of merchants. The
PhilGEPS office’s evaluation of the eligibility requirements shall be for the sole
purpose of determining the approval or disapproval of the merchant’s application
for registration.

b. A merchant’s registration and membership in the GOP-OMR is neither

contract-specific nor understood to be tantamount to a finding of eligibility.
 Neither shall the merchant’s successful registration in the GOP-OMR be relied
upon to claim eligibility for the purpose of participation in any public bidding.

c. The determination of the eligibility or merchants, whether registered with the

GOP-OMR or not shall remain with the Bids and Awards Committee (BAC). The
BAC’s determination of validity of the eligibility requirements shall be conclusive
to enable the merchant to participate in the public bidding process.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of __, 20__ at
_____________________, Philippines.

Bidder’s Representative/Authorized Signatory

SUBSCRIBED AND SWORN TO before me this ___________________ at

Mangaldan, Pangasinan, Philippines.

Doc No.
Page No.
Book No.
Series of 2017