Republic of the Philippines) Province of Laguna ) Municipality of i AFFIDAVIT L _,:«soof:=slegal «age, Filipino and _ residing at ; after having been duly sworn in accordance with law, do hereby depose and say : 1. That, Iam the owner of located at 2, That is not “Blacklisted” from the list of supplier/bidder by the Government of the Philippines or any of its agencies, offices, corporations or Local Government Units whose blacklistings rules have been recognized by the Government Procurement Policy Board; 3. That, is not related to the Head of the Procuring Entity by consanguinity or affinity up to the third civil degree. IN WITNESS WHEREOF, I have hereunto set my hand this day of 2017 at a ' Affiant Id No. SUBSCRIBED AND SWORN to before me this ___day of 2017 at Notary Public Doc agen Book Series