Omnibus Sworn Statement Template printable pdf download

Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ______ ) S.S.

A F F I D A V I T

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of

Affiant], 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 of [Name of Bidder] with office address

at [address of Bidder];

If a partnership, corporation, cooperative, or joint venture: I am the duly authorized and

designated representative of [Name of Bidder] with office address at [address of Bidder];

2. Select one, delete the other:

If a sole proprietorship: As the owner and sole proprietor of [Name of Bidder], I have

full power and authority to do, execute and perform any and all acts necessary to

represent it in the bidding for [Name of the Project] of the [Name of the Procuring

Entity];

If a partnership, corporation, cooperative, or joint venture: I am granted full power and

authority to do, execute and perform any and all acts necessary and/or to represent the

[Name of Bidder] in the bidding as shown in the attached [state title of attached

document showing proof of authorization (e.g., duly notarized Secretary’s Certificate

issued by the corporation or the members of the joint venture)];

3. [Name of Bidder] is not “blacklisted” or barred from bidding by the Government of the

Philippines or any of its agencies, offices, corporations, or Local Government Units, foreign

government/foreign or international financing institution whose blacklisting rules have been

recognized by the Government Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the bidding requirements is an authentic

copy of the original, complete, and all statements and information provided therein are true

and correct;

5. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly authorized

representative(s) to verify all the documents submitted;

Omnibus Sworn Statement Template