SWORN STATEMENT

I, ______(name)________, of legal age, (civil status), (citizenship), and

residing at __________(address)_________________, after having been sworn in
accordance with law, do hereby depose and state that:

a. I am the duly authorized and designated representative of

___________(name of organization)_____________with office address
at__________(address)_________________,;
b. I am granted full power and authority to do, execute and perform
any and all acts necessary and/or to represent the ________(name of
organization)____ as the ________(desination)_______________;
c. The _________(name of organization)______ is an independent, non-
partisan organization;
d. Each of the documents submitted in satisfaction of the
accreditation for membership requirements is an authentic copy of
the original, complete, and all statements and information provided
therein are true and correct;
e. The _________(name of organization)______ will retain its autonomy
while pursuing the advancement of the people’s interest through its
membership in a local special body, after satisfying all the
requirements and set criteria, as stated in
__________________________ dated ____________, and after securing a
Certificate of Accreditation from the Sangguniang Bayan of
______________.

IN WITNESS WHEREOF, I have hereunto set my hand this ______day of

__________, 20___ at ___________________________________.

_______________________
(Designation)