REPUBLIC OF THE PHILIPPINES )

_____________________________ )
_____________________________ ) S.S.

AFFIDAVIT

I, LANI-ROHANI M. KOUZBARY, of legal age, married with postal address at 100 Macapagal
Avenue, Camague, Iligan City, after having duly sworn to in accordance with the law, hereby depose and say:

That I am the Authorized Managing Ofiicer of PREMIUM MEGASTRUCTURES, INC./KOUZBARY

BUILDERS (JV), a Filipino corporation duly organized under the existing laws of the Republic of the Philippines.

That the of PREMIUM MEGASTRUCTURES, INC./KOUZBARY BUILDERS (JV) has a Contract with
the Republic of the Philippines under the Department of Public Works and Highways (DPWH) Region 10, Cagayan De
Oro City.

That the said Contract is for 19K00258 – Construction/Replacement of Dago-ok Bridge,

Lumbatan, along Lake Lanao Circumferential Road), Lanao del Sur,

That in compliance with Department Circular No. 17 Series of 1996, the PREMIUM MEGASTRUCTURES,
INC./KOUZBARY BUILDERS (JV), hereby states the gross receipts have been declared with Bureau of Internal
Revenue for Income Tax purposes;

That, we have submitted our Monthly Certificate of Payment No. 4 for our construction works for the period
covering December 29, 2019-March 04, 2020;

That we have not given any money or gift, nor made promises of anything to any persons, employees or officer
of the Department of Public Works and Highways in connection to the said project;

That PREMIUM MEGASTRUCTURES, INC./KOUZBARY BUILDERS (JV) has fully paid all
workers/laborers, subcontractor, suppliers and all persons or parties who have done or finished materials supplied,
supplied services, and other inputs on work accomplished on the project as of December 29, 2019-March 04,
2020;and such payments were all in accordance with law;
That this affidavit is being executed to support our claim for the Final for work accomplished anent above said
project and to comply with the legal requirements.

IN WITNESS WHEREOF, I have That I am the General Manager of PREMIUM

MEGASTRUCTURES, INC./KOUZBARY BUILDERS (JV) unto affixed my signature this 28th day of
December 2020 at
Iligan City.

LANI-ROHANI M. KOUZBARY
General Manager

SUBSCRIBED AND SWORN to before me this ____day of _________ at

_________________________ Affiant exhibition to me his Res. Cert. No. __________ issued on
_______________ at ____________.

Doc. No. : __________________

Page No. : __________________
Book No. : __________________
Series of : _________________ __________________
Notary Public