Contractors AFFIDAVIT

Department of Trade & Industry Philippines
Construction Industry Authority of the Philippines

PHILIPPINE CONTRACTORS ACCREDITATION BOARD
PCAB-QMS-CLR-AFF-F16 Revision No. 00, 01AUG2022 | This Form is NOT for sale. Reproduction is Allowed
AFFIDAVIT
I, JEFFREY REPOSO BERNATE, the Authorized Managing Officer of GODIC CIVIL ENGINEERING
CONSTRUCTION, holder of Contractor's License No. N/A , originally issued on N/A, with the principal office
address (as stated in the SEC) P-1, BERNATE CMPD., BRGY, CAPOOCAN, CALBAYOG CITY, SAMAR,
having been duly auth0rized to file for this PCAB License Application, hereby request that its application for
Contractor’s License be approved.
After having duly sworn to in accordance with law hereby depose and state that:
1. I affirm 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. I certify 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. I certify furthermore that the Social Security System (SSS), Pag-IBIG, and PhilHealth contributions were remitted
in favor of the employees of this firm.
5. PCAB is 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 919-990-272-001
(This serves as a waiver on the confidentiality provision of Section 270 of the National Internal Revenue
Code of 1997 (Memorandum Circular No. 28, s 2006 dated May 08, 2006, and your authorization to
release any information that may be requested by PCAB)
c. Social Security System (SSS): 80-0266533-5-000

d. Pagtutulungan sa Kinabukasan: Ikaw, Bangko, Industriya at Gobyerno (Pag-IBIG): 210059570008
e. Philippine Health Insurance Corporation (PhilHealth): 013000010509
f. Professional Regulation Commission (PRC) for the following Sustaining Technical Employees (STEs)
with their signatures:
1. Robsper L. Cajiles – 0120927 – Signature and Date
g. National Bureau of Investigation (NBI) for the AMO and following STEs.
1. Jeffrey R. Bernate________________________
2. Robsper L. Cajiles________________________
h. Land Registration Authority (LRA) for the following TCT with Nos.
1. NONE________________________________
2. ______________________________________
i. Land Transportation Office (LTO) for the following vehicles with OR and CR Nos.
1. ______________________________________
2. ______________________________________
j. List of Heavy Construction Equipment:
1. Hydraulic Excavator, Engine No.: 94051A_________
2. 6 cubic Dump Truck, Engine No.: WD61547200907038587 _
3. 5 cubic Transit Mixer, Engine No.:
4. Hydraulic Excavator, Engine No.:
k. Local Government Units (LGUs)
l. Other Government Agencies
PCAB-QMS-CLR-AFF-F16 Revision No. 00, 01AUG2022
This Form is NOT for sale. Reproduction is Allowed
Page 2 of 3
m. This firm’s depository bank:
Name of Bank: __________________________

Name of Manager: __________________________
Bank Account Number: __________________________
Name of Bank: __________________________

Name of Manager: __________________________
Bank Account Number: __________________________
(This serves as a 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 clients/project owners as indicated in its statement of work accomplished/on-going.
6. I hereby 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. I am 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 criminal charges and cases against me and my firm notwithstanding the disapproval of
my firm’s application, denial/suspension/revocation of license and blacklisting of my firm and
myself as its Authorized Managing Officer;
b. Unconfirmed information/documents submitted to support my firm's qualifications shall be

excluded for categorization/classification purpose; and
c. 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.
________JEFFREY R. BERNATE_________
Authorized Managing Officer (AMO)
(Signature and date over Printed Name)
Republic of the Philippines )

Province of __SAMAR__)
City/Municipality of _CALBAYOG_) S.S
SUBSCRIBED AND SWORN to before me this ________ day of _________________________ 20____ at

_____________________________________________; affiant exhibited to me his/her Government issued
Identification Card ______________________________ issued at _________________________ on
_____________ 20 ___.
NOTARY PUBLIC
Until December 31, 20 ____
Doc. No.
Page No.
Book No.
Series of 20 __.
PCAB-QMS-CLR-AFF-F16 Revision No. 00, 01AUG2022
This Form is NOT for sale. Reproduction is Allowed
Page 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
our tasks guided by ethical standards and equipped with the necessary capability for the successful prosecution of our
contracts.
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 clear 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 carrying out our contractual
obligations, and as far as possible, within the stipulated time of completion;
 We are aware that we will be imposed disciplinary action should we violate any of the commitments hereof or
the PCAB Code of Ethics or be found to be a party to corruption.
_____JEFFREY R. BERNATE________
Authorized Managing Officer (AMO)
(Signature and date over Printed Name)
__GODIC CIVIL ENGINEERING CONSTRUCTION __

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Contractors AFFIDAVIT

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Department of Trade & Industry Philippines

Construction Industry Authority of the Philippines

1. I affirm the Integrity Pledge included in this Affidavit.

a. Securities and Exchange Commission (SEC)

c. Social Security System (SSS): 80-0266533-5-000

m. This firm’s depository bank:

Name of Bank: __________________________

Name of Bank: __________________________

7. I am fully aware that:

a. Any discovered misrepresentation of information encoded or attached as a document and/or

b. Unconfirmed information/documents submitted to support my firm's qualifications shall be

AFFIANT FURTHER SAYETH NAUGHT.

Republic of the Philippines )

SUBSCRIBED AND SWORN to before me this day of _____________ 20 at

PCAB INTEGRITY PLEDGE

In view thereof, we pledge the following:

GODIC CIVIL ENGINEERING CONSTRUCTION

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