Omnibus Sworn Statement
REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF ______ ) S.S.
AFFIDAVIT
I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at
[Address of Affiant], after having been duly sworn in accordance with law, do hereby
depose and state that:
1. Select one, delete the other:
If a sole proprietorship: I am the sole proprietor of [Name of Bidder] with office
address at [address of Bidder];
If a partnership, corporation, cooperative, or joint venture: I am the duly
authorized and designated representative of [Name of Bidder] with office address
at [address of Bidder];
2. Select one, delete the other:
If a sole proprietorship: As the owner and sole proprietor of [Name of Bidder], I
have full power and authority to do, execute and perform any and all acts
necessary to represent it in the bidding for [Name of the Project] of the [Name of
the Procuring Entity];
If a partnership, corporation, cooperative, or joint venture: I am granted full
power and authority to do, execute and perform any and all acts necessary and/or
to represent the [Name of Bidder] in the bidding as shown in the attached [state
title of attached document showing proof of authorization (e.g., duly notarized
Secretary’s Certificate issued by the corporation or the members of the joint
venture)];
3. [Name of Bidder] is not “blacklisted” or barred from bidding by the Government
of the Philippines or any of its agencies, offices, corporations, or Local
Government Units, foreign government/foreign or international financing
institution whose blacklisting rules have been recognized by the Government
Procurement Policy Board;
4. Each of the documents submitted in satisfaction of the bidding requirements is an
authentic copy of the original, complete, and all statements and information
provided therein are true and correct;
5. [Name of Bidder]is authorizing the Head of the Procuring Entity or its duly
authorized representative(s) to verify all the documents submitted;
6. Select one, delete the rest:
If a sole proprietorship: I am not related to the Head of the Procuring Entity,
members of the Bids and Awards Committee (BAC), the Technical Working
Group, and the BAC Secretariat, the head of the Project Management Office or
the end-user unit, and the project consultants by consanguinity or affinity up to
the third civil degree;
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Omnibus Sworn Statement
PROVISION OF SECURITY SERVICES (2018)
If a partnership or cooperative: None of the officers and members of [Name of
Bidder] is related to the Head of the Procuring Entity, members of the Bids and
Awards Committee (BAC), the Technical Working Group, and the BAC
Secretariat, the head of the Project Management Office or the end-user unit, and
the project consultants by consanguinity or affinity up to the third civil degree;
If a corporation or joint venture: None of the officers, directors, and controlling
stockholders of [Name of Bidder] is related to the Head of the Procuring Entity,
members of the Bids and Awards Committee (BAC), the Technical Working
Group, and the BAC Secretariat, the head of the Project Management Office or
the end-user unit, and the project consultants by consanguinity or affinity up to
the third civil degree;
7. [Name of Bidder] complies with existing labor laws and standards; and
8. [Name of Bidder] is aware of and has undertaken the following responsibilities as
a Bidder:
a) Carefully examine all of the Bidding Documents;
b) Acknowledge all conditions, local or otherwise, affecting the implementation
of the Contract;
c) Made an estimate of the facilities available and needed for the contract to be
bid, if any; and
d) Inquire or secure Supplemental/Bid Bulletin(s) issued for the [Name of the
Project].
9. [Name of Bidder] did not give or pay directly or indirectly, any commission,
amount, fee, or any form of consideration, pecuniary or otherwise, to any person
or official, personnel or representative of the government in relation to any
procurement project or activity.
IN WITNESS WHEREOF, I have hereunto set my hand this __ day of ___, 20__ at
____________, Philippines.
_____________________________________
[Bidder’s Representative/Authorized Signatory]
[JURAT]
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Omnibus Sworn Statement
PROVISION OF SECURITY SERVICES (2018)
SUBSCRIBED AND SWORN to before me this ___ day of [month] [year] at
[place of execution], Philippines. Affiant/s is/are personally known to me and was/were
identified by me through competent evidence of identity as defined in the 2004 Rules on
Notarial Practice (A.M. No. 02-8-13-SC). Affiant/s exhibited to me his/her [insert type of
government identification card used], with his/her photograph and signature appearing
thereon, with no. ________ and his/her Community Tax Certificate No. _______ issued
on ____ at ______.
Witness my hand and seal this ___ day of [month] [year].
NAME OF NOTARY PUBLIC
Serial No. of Commission _______________
Notary Public for _______ until __________
Roll of Attorneys No. __________________
PTR No. ______ [date issued], [place issued]
IBP No. ______ [date issued], [place issued]
Doc. No. _____
Page No. _____
Book No. _____
Series of _____
* This form will not apply for WB funded projects.
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Omnibus Sworn Statement
PROVISION OF SECURITY SERVICES (2018)
BID SECURING DECLARATION FORM
REPUBLIC OF THE PHILIPPINES)
CITY OF _______________________) S.S.
x------------------------------------------------------x
BID SECURING DECLARATION
Invitation to Bid: [Insert Reference number]
To: [Insert name and address of the Procuring Entity]
I/We1, the undersigned, declare that:
1. I/We understand that, according to your conditions, bids must be supported by a
Bid Security, which may be in the form of a Bid-Securing Declaration.
2. I/We accept that: (a) I/we will be automatically disqualified from bidding for any
contract with any procuring entity for a period of two (2) years upon receipt of
your Blacklisting order; and, (b) I/we will pay the applicable fine provided under
Section 6 of the Guidelines on the Use of Bid Securing Declaration, within fifteen
(15) days from receipt of the written demand by the procuring entity for the
commission of acts resulting to the enforcement of the bid securing declaration
under Sections 23.1(b), 34.2, 40.1 and 69.1, except 69.1(f), of the IRR of RA
9184; without prejudice to other legal action the government may undertake.
3. I/We understand that this Bid Securing Declaration shall cease to be valid on the
following circumstances:
(a) Upon expiration of the bid validity period, or any extension thereof
pursuant to your request;
(b) I am/we are declared ineligible or post-disqualified upon receipt of your
notice to such effect, and (i) I/we failed to timely file a request for
reconsideration or (ii) I/we filed a waiver to avail of said right;
(c) I am/we are declared the bidder with the Lowest Calculated Responsive
Bid, and I/we have furnished the performance security and signed the
Contract.
1. Select one and delete the other. Adopt same instruction for similar terms throughout the document.
BID SECURING DECLARATION
PROVISION OF SECURITY SERVICES (2018)
IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this ____ day of
[month] [year] at [place of execution].
[Insert NAME OF BIDDER’S AUTHORIZED
REPRESENTATIVE]
[Insert Signatory’s Legal Capacity]
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of [month] [year] at [place of
execution], Philippines. Affiant/s is/are personally known to me and was/were identified by me
through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M.
No. 02-8-13-SC). Affiant/s exhibited to me his/her [insert type of government identification card
used], with his/her photograph and signature appearing thereon, with no. ________ and his/her
Community Tax Certificate No. _______ issued on ____ at ______.
Witness my hand and seal this ___ day of [month] [year].
NAME OF NOTARY PUBLIC
Serial No. of Commission _______________
Notary Public for _______ until __________
Roll of Attorneys No. __________________
PTR No. ______ [date issued], [place issued]
IBP No. ______ [date issued], [place issued]
Doc. No. _____
Page No. _____
Book No. _____
Series of _____
1. Select one and delete the other. Adopt same instruction for similar terms throughout the document.
BID SECURING DECLARATION
PROVISION OF SECURITY SERVICES (2018)
