ANNEX 2-21 PRO-FORMA SWORN STATEMENT OF ACCOUNTABILITY OF PROPONENT

SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT*

This is to certify that all the information and commitments in this REPORT for the (state name of project) PROJECT are accurate and complete to the best of our knowledge, and that an objective and thorough assessment of the Project was undertaken in accordance with the dictates of professional and reasonable judgment. Should I/we learn of any information, which would make this (state one of the 7 EIA report types) REPORT inaccurate, I shall immediately bring the said information to the attention of DENR-EMB.
(state one of the 7 EIA report types)

I hereby certify that no DENR-EMB personnel was directly involved in the preparation of this (state name of project) REPORT other than to provide procedural and technical advice consistent with the guidelines in the DAO 03-30 Revised Procedural
Manual.

I hereby bind myself to answer any penalty that may be imposed arising from any misrepresentation or failure to state material information in this (state one of the 7 EIA report types) REPORT. In witness whereof, I hereby set my hand this ____ day of __________ at ______________________. ____________________ NAME OF PROPONENT HEAD (Position) (Company Name) SUBSCRIBED AND SWORN TO before me this _____ day of ____________ 200_, affiant exhibiting his/her Community Tax Certificate No. ___________________ issued at ______________________ on __________________________.

Doc. No. Page No. Book No. Series of

____________________ ____________________ ____________________ ____________________

* The Sworn Statement of Accountability of the Proponent shall be part of ALL seven (7) EIA Report Type submissions PEIS, EIS, PEPRMP, EPRMP, IEER, IEEC and PD Report.

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