Disclosure of No Relationship Affidavit

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AFFIDAVIT OF DISCLOSURE OF NO RELATIONSHIP

I, __________________________________ , of legal age, __________________________,


_______________________, and residing at __________________________________________, after
having been duly sworn in accordance with law, do hereby depose and state:

1. That I am the registered owner of _____________________________________________, with


office address at _________________________________________________________.

2. That none of the officers / directors / controlling stockholders / members /owners of the firm are
related by consanguinity or affinity up to the 1st civil degree to the CNSPMC Chairperson or
employees of KC-PMNP Regional Program Management Office (RPMO) or National Program
Management Office (NPMO) who are having direct access to information that may substantially
affect the result of the bidding, such as, but not limited to, the members of the Bids and Awards
Committee (BAC), the members of the Technical Working Group (TWG), the Procurement Team
(PT), and the designer/s of the Sub-project.

3. That the above statement is true for the all the barangays in the municipality/municipalities of
_________________________________________________.

________________________________
Affiant

ACKNOWLEDGEMENT

BEFORE ME, Notary Public for and the Municipality of ___________________, personally appeared
___________________________ (name of bidder) with residence certificate No. _________________
issued on _________________ at ________________________ in his capacity as Authorized Signing
Official or ___________________________________ of ___________________________________
known to me to be the same person who executed the foregoing Certification and acknowledge to me
that the same is his/her true act and deeds for and behalf of the firm he/she represents.

This instrument consists of one page including this page on which the ACKNOWLEDGEMENT is
written duly signed by the Authorized Signing Officer.

IN WITNESS WHEREOF, I have hereunto affixed my signature and seal this ______ day of
_____________________, 2024 at _________________________________________________.

NOTARY PUBLIC
Until December ___, 202___
PTR NO. ______________
Issued at ______________
Issued on ______________

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