Affidavit of Disclosure of No Relationship
I,_______________________________,
Filipino,
of
legal
single/married,
and
a
resident
__________________________________________________________,
having duly sworn to in accordance with law, hereby depose and state;
age,
of
after
That I am the owner/president/general manager/authorized representative
of ______________________ _______________________________________.
a bidder in the public bidding to be conducted by the Bids and Awards
Committee (BAC)/BAC Sub-Committee/Procurement Division of the Manila
International
Airport
Authority
(MIAA)
for
the
_______________________________________________________________.
That I am not (none of our officers and/or members of the partnership
are/none of the officers, directors, or controlling stockholders of our corporation
are) in any way related to the head of MIAA either by consanguinity or affinity up
to the third civil degree;
That neither am I (nor any of the officers and/or members of the
partnership are/none of the officers, directors, or controlling stockholders of our
corporation are) related to any members of the MIAA-BAC, BAC Sub-Committee,
Procurement Division, its Secretariat, and/or its Technical Working Group (TWG)
or any of its officers or employees having direct access to information that may
substantially affect the result of the bidding, either by consanguinity or affinity up
to the third civil degree;
That I am (we are) executing this Affidavit/Disclosure of Relations in
compliance with Section 47 of the Implementing Rules and Regulations of
Republic Act No. 9184, otherwise known as “The Government Procurement
Reform Act.
AFFIANT FURTHER SAYETH NONE.
____________
Affiant
Republic of the Philippines
Province/City of __________________) S.S.
Subscribed and sworn to before me this ______ day of __________,
20___ at ________________________, Philippines. Affaint exhibit to me his/her
Community Tax Certificate No. _____________ issued on _________________
at ___________________________.
Doc. No.:
Page No.:
Book No.:
Series of
_____________
_____________
_____________
_____________
Notary Public
Until:
______________
PTR No.: ______________
Date:
______________
Place: ______________
______________
TIN: