| Local Government Unit
of General Santos City
Project Reference Number _____________________ Name of the Project __________________________
Standard Form Number: SF-GOOD-19 Revised on: May 24, 2004
I, ___(Representative of the Bidder)___, of legal age, __(civil status)__, Filipino and residing at ___(Address of the Representative)_, under oath, hereby depose and say:
1. That I am the __(Position in the Bidder)__ of the ___(Name of the Bidder)___, with office at ___(Address of the Bidder)___;
2. That each of the documents submitted is an authentic and original copy or a true and faithful reproduction of the original, complete and that all statements and information provided therein are true and correct;
3. That I am making this statement as part of the eligibility requirement of __(Name of the Bidder)__ for __(Name of the Project)__. IN FAITH WHEREOF, I hereby affix my signature this _____ day of _____, 20___ at _____________, Philippines.
_________________ AFFIANT SUBSCRIBED AND SWORN TO before me this _________, day of ______ 2003, affiant exhibiting to me his/her Community Tax Certificate No. ________________ issued on _________ at _____________________, Philippines.
_______________________ (Notary Public)
Until
_________ Doc. No. _______ Page No. _______ Book No. _______ Series of _______ |