PhilGEPS Sworn Statement

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ______ ) S.S.

AFFIDAVIT

I, Corazon Pelagia A. Altar, of legal age, Widow, Filipino, and residing at [Brgy. 05, Gen.
MacArthur, Eastern Samar, after having been duly sworn in accordance with law, do hereby
depose and state that:

1. Select one, delete the other:

If a sole proprietorship: I am the sole proprietor or authorized representative of Corazon

Pelagia A.Altar with office address at Brgy. 05,Gen. MacArthur, Eastern Samar;

2. As the owner and sole proprietor, or authorized representative of Corazon Pelagia A.

Altar, as shown in the attached duly notarized Secretary’s Certificate, Board/Partnership
Resolution, or Special Power of Attorney, whichever is applicable;, 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 its 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 of 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.

CORAZON PELAGIA A. ALTAR

Bidder’s Representative/Authorized Signatory

[JURAT]