GAWAD KALASAG OMNIBUS SWORN STATEMENT FOR THE
CERTIFICATION OF AUTHENTICITY AND VERACITY OF
DOCUMENTS
I,
[NAME]
[ADDRESS]
1. That I am the
, Filipino, of legal age, with permanent address at
, do hereby depose and state under oath:
[Mayor/Local
DRRM
Officer/Local
authorized by the Local DRRM Officer]
PROVINCE]
of
DRRM
Staff
duly
[NAME OF LGU,
;
2. That I have conducted an honest self-assessment of my Local DRRM Council/Office using
the prescribed Local DRRM Office/Council Assessment Tool, pursuant to the NDRRMC
Memorandum Circular 3 s. 2025;
3. That each of the document submitted is a true and faithful reproduction of the original,
complete and that all statements and information provided therein are true and accurate;
4. That all the information provided in the document is within the prescribed assessment
period, covering January 2024 to December 2024;
5. That I am assuming full responsibility and accountability on the validity and authenticity
of the documents submitted;
6. That I am aware that any violation thereof will automatically disqualify the Local
Government Unit from the Gawad KALASAG selection process;
7. That I am making these statements as part of the requirement for the Gawad KALASAG
Seal for Excellence in Disaster Risk Reduction and Management and Humanitarian
Assistance.
[NAME]
[City/Municipal Mayor/Local DRRM Officer]
[NAME OF LGU, PROVINCE]
SUBSCRIBED AND SWORN to before me this ______ day of ___________, 20___ at
_______________________, Philippines. Affiant exhibited to me his/her [ID TYPE], with his/her
photograph and signature appearing thereon, with ID No. _______________________, issued on
____________ at ________________________.
NOTARY PUBLIC