SWORN ACCOUNTABILITY STATEMENT OF PREPARER

This is to certify that all information in this ______________________________ Report

for the ___________________________ are accurate and complete in 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 judgement. Should we learn of any
information which would make this Report inaccurate, we shall immediately bring the said
information to the attention of the DENR-EMB.
We hereby certify that no DENR-EMB personnel was directly involved in the preparation
of this Report other than to provide procedural and technical advice consistent with the
guidelines in the DAO 03-30 Revised Procedural Manual.
We hereby bind ourselves jointly and solidarily to answer for any penalty that may be
imposed arising from any misrepresentations or failure to state material information in this
Report.
In witness whereof, I/we hereby set our hands this _______ day of
___________________ at ___________________________.

Name Field of Expertise Signature

1.
2.
3.
4.
5.

SUBSCRIBED AND SWORN TO before me this _______ day of ___________, 2023, affiants exhibiting
their Community Tax Certificate Information as follows:

Name Community Tax Certificate Information

1.
2.
3.
4.
5.

Doc No. _____ _______

Page No. ____ Notary Public
Book No. ____
Series of 2023