REPUBLIC OF THE PHILIPPINES, )

Province of Laguna S.s

City of Calamba )

CONTRACTOR’S AFFIDAVIT

I,_______________________ of legal age, married, Filipino and a resident of

___________________, Laguna, after having sworn in accordance with law, hereby
depose and state:

That I am the General Manager of ___________________, a company duly organized

under the law of the Republic of the Philippines with business address at
________________, Brgy. ____, City of ______________;

That ________________________ is the contractor of the said project, SUPPLY,

DELIVERY AND PLANTING OF TREES located at ______________ as per Purchase
Order No______________ dated ____________________;

That I have no outstanding obligation or whatsoever with respect to the salaries, wages
and bonuses of laborers and I had fully paid my Creditors and Suppliers with respect to
the materials in the construction of the said project;

That this affidavit is being issued as a supporting document for our billing purposes and
for whatsoever it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th day of February 2021 at
the City of Calamba, Laguna.

_____________________
Affiant

SUBSCRIBED and SWORN to before me this ____ th day of _____________ in the City
of Calamba, Laguna, Affiant, exhibited to me her Driver’s License with Nos.
________________ which will expire on ______________.

Doc. No.
Page No.;
Book No. ;
Series of