Department of Public Works and Highways (DPWH)

Contract ID:
Contract Name:
Location of the Contract:
-----------------------------------------------------------------------------------------AFFIDAVIT OF SITE INSPECTION

I, _____________________________, of legal age, ______________, Filipino and residing

Representative of the Bidder
civil status
at _______________________________, under oath, hereby depose and say:
Address of the Representative
1. That I am the _______________________ of the ______________________, with office
Position in the Bidder
Name of the Bidder
at ________________________;
Address of the Bidder
2. That I have inspected the site for ___________________________________, located at
Name of the Contract
_________________________;
location of the Contract
3.

That I am making this statement as part of the requirement for the Technical Proposal of
the ________________________ for ____________________________.
Name of the Bidder
Name of the Contract

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)

Doc. No. _______

Page No. _______
Book No. _______
Series of _______

Until
PTR No.
Date
Place
TIN

_________
_________
_________
_________
_________

---------------------------------------------------------------------------------------------------------------------DPWH-INFR-45-072105
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