Você está na página 1de 3

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S. S.

AFFIDAVIT OFDISCLOSURE OF RELATION


I, GLORIA DEALA, of legal age, Filipino, for and in representation of my
husband REY DEALA, the Owner of REY DEALA METAL CRAFT with office and
postal address at 171 Miguelin St., Sampaloc, Manila, after having been duly
sworn to in accordance with law hereby depose and say: That 1. I am an established and reputable Supplier of plaque, company pin,
medals, key chain and other metal crafts;
2. None of my authorized officers employed staff, sub-contractors
consultant or any other party forming or having any direct or indirect
relationship with REY DEALA METAL CRAFT are related to the head of
the PROCURING ENTITY by consanguinity or affinity up to the third civil
degree and to the same degree, any of the Procuring Entitys officers or
employees having direct access to information that may substantially
affect the result of the bidding, such as, but not limited to, the members
of the Bids and Awards Committee, the members of the Technical
Working Group, the Bids and Awards Committee Secretariat, the
members of any Project Management Office in trading the procurement,
and the designers of the project;
3. I understand and accept that my false statements in this respect will
render REY DEALA METAL CRAFT and its authorized officers liable for
prosecution to the full extent of the law.
DONE this 23rd day of February 2005 in Quezon City, Philippines.

REY DEALA METAL CRAFT


by:
GLORIA DEALA
Affiant
SUBSCRIBED AND SWORN to before me this 23rd day of February 2005 in
Quezon City, Philippines, Affiant exhibited to me her Community Tax Cert. No.
______________ issued on ___________ in _______________.

Doc. No. _______:


Page No. _______:
Book No. ______:
Series of 2005.

Notary Public

REPUBLIC OF THE PHILIPPINES )


QUEZON CITY, METRO MANILA ) S. S.

AFFIDAVIT OF DISCLOSURE OF RELATION


I, NESTOR PAYUMO, of legal age, Filipino, for and in representation of
EVERTEL PHILS. CORPORATION, with office and business address at # 3 rd Flr. #
356 Gregorio Araneta Ave., Brgy. Doa Imelda, Quezon City, after having been
duly sworn to in accordance with law hereby depose and say: That 1. That I am the authorized representative of an establishment known
as Evertel Phils. Corporation, a corporation duly organized and
existing under the laws of the Philippines with office address located at
the above-mentioned address;
2. That as such authorized person, I personally knew the fact that none of
officers employed staff, sub-contractors consultant or any other party
forming or having any direct or indirect relationship with EVERTEL
PHILS. CORP. are related to the head of the PROCURING ENTITY by
consanguinity or affinity up to the third civil degree and to the same
degree, any of the Procuring Entitys officers or employees having
direct access to information that may substantially affect the result of
the bidding, such as, but not limited to, the members of the Bids and
Awards Committee, the members of the Technical Working Group, the
Bids and Awards Committee Secretariat, the members of any Project
Management Office in trading the procurement, and the designers of the
project;
3. That I understand and accept that my false statements in this respect
will render EVERTEL PHILS. CORP. and its officers liable for
prosecution to the full extent of the law.
DONE this _______ day of April, 2005 in Quezon City, Philippines.

EVERTEL PHILS. CORP.


by:
NESTOR PAYUMO
Affiant
SUBSCRIBED AND SWORN to before me this _______ day of April, 2005 in
Quezon City, Philippines, Affiant exhibited to me his Community Tax Cert. No.
______________ issued on ___________ in _______________.

Doc. No. _______:


Page No. _______:
Book No. ______:
Series of 2005.

Notary Public

CERTIFICATION
I, EMILY SURATOS, of legal age, Filipino, as the Administrative Manager of
EVERTEL PHILS. CORPORATION, a corporation duly organized and existing
under the laws of the Philippines, with office and business address at 3 rd Flr. #
356 Gregorio Araneta Ave., Brgy. Doa Imelda, Quezon City, do hereby certify that
each of the documents submitted to the procuring entity, Philippine Coconut
Authority (PCA), in satisfaction of the eligibility requirements is an authentic and
original copy or a true and faithful reproduction or copy of the original, complete,
and that all statements and information provided therein are true and correct.
SIGNED this _____ day of April 2005 in Quezon City, Philippines.

EMILY SURATOS
Administrative Manager

SUBSCRIBED AND SWORN to before me this ______ day of April 2005 in


Quezon City, Affiant exhibited to me her Community Tax Certificate No.
___________ issued on ______________ at _______________.

Doc. No. _______;


Page No. _______;
Book No. _______;
Series of 2005.