REPUBLIC OF THE PHILIPPINES)

Done in the City of ________ ) Sc.

AFFIDAVIT
KNOW ALL MEN BY THESE PRESENTS:

I, ____________________, of legal age, Filipino citizen and a resident of

________________________________ having been duly sworn to in accordance with law, do
hereby depose and state, that:

1. I am a Professional Electronics & Communication Engineer by profession, as a

consequence thereof I was issued the corresponding PRC License bearing no. _____;
copy of my PRC License and PTR are hereto attached for reference;

2. ____________________ is the original designer of an on going project described as

follows, to wit:

Project Title: ____________________________

Owner of Project/company: ______________________
Location: _______________________________

3. I am taking over the profession responsibility of the aforesaid original designer-

_________________ who is a holder of PRC License No. ______ for the reason that
said ______________ was no longer connected in our company;

4. I have checked and reviewed the design made by ______________, conducted thorough
inspection of all the installations and construction works and based on my professional
competence, I am taking full responsibility for the design and completion of the above-
mentioned project.

5. I am executing this Affidavit to attest to the truthfulness and veracity of the foregoing
narration of facts; and for whatever legal intents and purposes this may well serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________ at
_________________ City, Philippines.

______________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ____________ at

________________. Affiant, whom I personally know through his PRC License No. ______, signed
the document in my presence and avowed under penalty of law to the whole truth of the contents of
the foregoing document.

WITNESS MY HAND AND SEAL.

Doc. No.: ____;

Page No.:____;
Book No.:____;
Series of 2011.