ao © Department of Trade & Industry Philippines : ra ay bey oe Papo Satie GoureacrOR® AccreDaon BOARD PCABF-SVD-O01e-1- Revision No. 00, 02/01/2021 | This Form is NOT for sale. Reproductions Alowed AFFIDAVIT 1, (name of Amo)_ ARNEL F. GOsoso . the Authorized Managing Officer (name F Constniction Firm) of, APG Consreucrtou SERVICES holder of Contractor's License No. , originally issued on (day/month/year) O& SEPrEMBER 2020, with the principal ‘fice ‘dares (as stated in the SEO) Buk 1G, LOTS , ECVERPE HOMES, BRGY QUILIE, ROSARIO, BATAN GAS iaving been duly authorized to Ble Tor this PCAB License Application, hereby request that ts application for Contractors License be approved. [After having duly sworn to in accordance with law hereby depose and state that: 1. Taffirm the Integrity Pledge included in this Affidavit. ‘2. I certify that the business name 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, Leertify to the truthfulness and authenticity of all information/documents encoded in the financial documentary requirements I have accomplished and the documents thereto attached are true and correct. 4. Toertify furthermore that the Social Security System (SSS), Pag-IBIG, and PhilHealth contributions were remitted in favor of the employees of this firm. 5. PCABis 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 PCAB License application filed with the PCAB: a. Securities and Exchange Commission (SEC) b. Bureau of Internal Revenue (BIR) for documents submitted for TIN Number 252" 851-725" (this serves as a waiver on the confidentiality provision of Section 270 of the National Internal Revenue Code of 1997 (Memorandum Cireular No. 28, s2006 dated May 08, 2006, and your authorization t0 release any information that may be requested by PCAB) Social Security System (SSS) Pagtutulungan sa Kinabukasan: Ikaw, Bangko, Industriya at Gobyerno (Pag-IBIG) Philippine Health Insurance Corporation (PhilFfealth) Professional Regulation Commission (PRC) for the following Engineers: L ARNEL F. GOSOSO 2 ome 3 & National Bureau of Investigation (NBI) for the AMO and following Engineers. 1. ARNEL F. GOsos0 2. 3. fh, Land Registration Authority (LRA) for the following TCT with Nos. 2 3. i, Land Tyansportation Office (LTO) for the following vehicles with OR and CR Nos. 2 3. J. List of Heavy Construction Equipment: 1 3 Kk. Local Government Units (LGUs) 1. Other Government AgenciesPCAB--SVD-0018-1. Revsion No. 00, 02/01/2021 ‘hie Form Is NOT forsale, Reproduction is lowed Pago 2 of 3 m, This firm’s depository bank: Name of Bank: UCP - LIPA Name of Manager: _AJARIVIC_A = TANT Bank Account Number: 202, 5606/96 = ‘Name of Bank: SecvRiny BAUK- TAFT Name of Manager: _ALVIN_PRE Bank Account Number: 0000 260£GG/1 (this serves as @ 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) n. This firm's elients/project owners as indicated in its statement of work accomplished/on-going, 6. Thereby certify to the truthfulness and authenticity of all information/documents encoded in the PCAB ONLINE, LICENSING PORTAL and contained in this application that information/documents hereto attached and encoded are true and correct. 7. Tam 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 eriminal charges and cases against me and my firm notwithstanding the disapproval of ‘ny firm's application, denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized Managing Officer; 1b. Unconfirmed information/documents submitted to support my firm's qualifications shall be ‘excluded for eategorization/ classification purpose; and ¢. 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. 8. 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. LF. Gososo 235ePr 202% ‘(Nampof AMO with signature and date) Republic of the Philippines ) Province of ) City/Municipality of _______) $$ SUBSCRIBED AND SWORN to before me this___ day of ____20__at ; affiant exhibited to me his/her Government issued YGentification Card _ issued at on 20 NOTARY PUBLIC Until December 31, 20 Doe. No. Page No. Book No. Series of 20 _.PCABF-SVD-00te-1. Revision No. 00, 0210/2021 “This Form is NOT for sale. Reproducionis Alowed Pago 3 of 3 PCAB INTEGRITY PLEDGE We believe that the construction industry is one of the most susceptible to all forms of corruption that hampers the noble objectives towards national progress and global competitiveness. ‘As frontrunners of nation-building, we acknowledge our major role and responsibility in ensuring that we carry out ical standards and equipped with the necessary capability for the successful prosecution of our In view thereof, we pledge the following: We will present only true qualifications to PCAB so that we may be evaluated properly and be given the category and classification where we should rightfully belong; We will uphold the dignity of the license and not be instruments for unlicensed contractors to undertake construction projects through license lending nor through false joint ventures/consortium or pseudo ‘combinations which is inimical to the public safety/interest; ‘We will not employ unlicensed sub-contractors/specialty contractors which is a elear circumvention of the requirement that all contractors must be licensed; We will absolutely shun away from any form of collusion that destroys the very essence and integrity of biddings; ‘We will not engage in bribery or do any act which constitutes graft or corrupt practice which is the root cause of bloated contract amounts; We will not use sub-standard materials which will in any way compromise the safety, reliability and performance of the built environment; We will not abandon our contracts and we will implement our projects faithfully in accordance with the prescribed specifications thereof; ‘We will provide the necessary resources, financial and technical capability in earrying out our contractual abligations, and as far as possible, within the stipulated time of completion; ‘We are aware that we will be imposed disciplinary acti the PCAB Code of Ethies or be found to be a pafy’to should we violate any of the commitments hereof or ELF. GOs0$0 ‘uthgfized Managing Officer (AMO) (Signature over Printed Name) AFG CONSTRUCTION SERYICES ‘Name of Company