Department of Trade & Industry Philippines

Construction Industry Authority of the Philippines

PHILIPPINE CONTRACTORS ACCREDITATION BOARD
RENEWAL OF REGULAR CONTRACTOR’S LICENSE APPLICATION
PCAB-F-SVD-002b-1. Revision No. 00, 05/14/2020 | This Form is NOT for sale. Reproduction is Allowed

AFFIDAVIT

I, (name of AMO)__________________________________________________, the Authorized

Managing Officer of (name of Construction Firm)
_____________________________________________________, holder of Contractor's License No.
_____________, originally issued on (day/month/year)________________, with the principal office address
(as stated in the DTI/SEC)
_________________________________________________________________________________
________________________________________________________________________________,
having been duly auth0rized to file for this PCAB License Renewal Application, hereby request for the Renewal of its
Contractor's License for Contracting Fiscal Year 20___ to 20___.

After having duly sworn to in accordance with law hereby depose and state that:

1. I continuously reaffirm the Integrity Pledge originally submitted by this firm to PCAB.

2. I certify that the business name (DTI) and/or Securities and Exchange Commission (SEC) registration of the
Construction firm is valid and existing, with the changes in the Owners/Stockholders/Directors/Officers and their
shareholdings as shown in the attached updated General Information Sheet (GIS).

3. I certify furthermore that the Social Security System (SSS), Pag-IBIG, and PhilHealth contributions were remitted
in favor of the employees of this firm.

4. PCAB is hereby authorized to verify and secure information and/or copies of documents submitted by or in the
name of the construction firm to any of the following agencies relative to its application for license renewal filed
with the PCAB:

a. Department of Trade & Industry (DTI) or Securities and Exchange Commission (SEC)
b. Bureau of Internal Revenue (BIR) for documents submitted for TIN Number ___________

(This serves as a waiver on the confidentiality provision of Section 270 of the National Internal Revenue
Code of 1997 (Memorandum Circular No. 28, s2006 dated May 08, 2006, and your authorization to
release any information that may be requested by PCAB)

c. Social Security System (SSS)

d. Pagtutulungan sa Kinabukasan: Ikaw, Bangko, Industriya at Gobyerno (Pag-IBIG)
e. Philippine Health Insurance Corporation (PhilHealth)
f. Professional Regulation Commission (PRC) for the following Engrs:
1.
2.
3.
4.
g. National Bureau of Investigation (NBI) for the AMO and following Engrs.
1.
2.
3.
4.
5.
h. Land Registration Authority (LRA) for the following TCT with Nos.
1.
2.
3.
i. Land Transportation Office (LTO) for the following vehicles with OR and CR Nos.
1.
2.
3.
4.
j. Local Government Units (LGUs)
k. Other Government Agencies
l. This firm’s depository bank:
 Renewal of Regular Contractor’s License Application
PCAB-F-SVD-002b-1. Revision No. 00, 05/14/2020
This Form is NOT for sale. Reproduction is Allowed
Page 2 of 2
Name of Bank: __________________________
Name of Manager: __________________________
Bank Account Number: __________________________

Name of Bank: __________________________

Name of Manager: __________________________
Bank Account Number: __________________________

(This serves as a waiver on the confidentiality provision of the Bank Secrecy Law and your
authorization to release any information that may be requested by PCAB in relation to the above-stated
bank account)
m. This firm’s clients/project owners as indicated in its statement of work accomplished/on-going.

5. I hereby certify to the truthfulness and authenticity of all information/documents encoded in PCAB’s ONLINE
RENEWAL SYSTEM and contained in this application that information/documents hereto attached and encoded
are true and correct.

6. I am fully aware that:

a. Any discovered misrepresentation of information encoded or attached as a document and/or

manifestations of fraud on the application documents submitted by my firm applicant or its
Authorized Representative/Agent/Liaison Officer shall be subjected to investigation which may
result to criminal charges and cases against me and my firm notwithstanding the disapproval of
my firm’s application, denial/suspension/revocation of license and blacklisting of my firm and
myself as its Authorized Managing Officer;

b. Unconfirmed information/documents submitted to support my firm's qualifications shall be

excluded for categorization/classification purpose; and

c. The evaluation of my firm’s qualifications shall be solely based on the documents submitted at the
time the application was filed/accepted by PCAB.

7. I further certify that I prepared this document, fully understood every word of it and its meaning, and have affixed
my signature hereunder voluntarily and freely with the full and complete knowledge of the meaning and intent of
this document as well as of my rights under existing laws.

AFFIANT FURTHER SAYETH NAUGHT.

______________________________
(Name of AMO with signature and date)

Republic of the Philippines )

Province of _________________)
City/Municipality of ___________) S.S

SUBSCRIBED AND SWORN to before me this ________ day of _________________________ 20____ at

_____________________________________________; affiant exhibited to me his/her Government issued
Identification Card ______________________________ issued at _________________________ on
_____________ 20 ___.

NOTARY PUBLIC
Until December 31, 20 ____

Doc. No.
Page No.
Book No.
Series of 20 __.