Omnibus Sworn Statement: Format, Requirements, and How to Complete It

Republic of the Philippines

City or Municipality of ______________ ) S.S.

OMNIBUS SWORN STATEMENT

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and with residence at [Address of Affiant], after having been duly sworn in accordance with law, do hereby depose and state that:

1. Select one and delete the others. If a sole proprietorship: I am the sole proprietor or authorized representative 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]. If an individual consultant not registered under a sole proprietorship, in consulting services: I am the individual consultant or authorized representative of [Name of Bidder] with office address at [Address of Bidder].
2. Select one and delete the others. As the owner and sole proprietor, or authorized representative of [Name of Bidder], I have full power and authority to do, execute, and perform any and all acts necessary to participate, submit the bid, and to sign and execute the ensuing contract for [Project Title] of the [Name of the Procuring Entity]. For a partnership, corporation, cooperative, or joint venture, I am granted full power and authority to do the same, as supported by the attached duly notarized Special Power of Attorney, Board or Partnership Resolution, or Secretary's Certificate, whichever is applicable.
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, or by a foreign government or foreign or international financing institution whose blacklisting rules have been recognized by the Government Procurement Policy Board, by itself or by relation, membership, association, affiliation, or controlling interest with another blacklisted person or entity.
4. Each of the documents submitted in satisfaction of the bidding requirements is an authentic copy of the original, is complete, and all statements and information provided in them are true and correct.
5. [Name of Bidder] is authorizing the Head of the Procuring Entity, or a duly authorized representative, to verify all the documents submitted.
6. Select one and delete the others. The owner or sole proprietor, the officers and members, or the officers, directors, and controlling stockholders, as applicable, are not related to the Head of the Procuring Entity, members of the Bids and Awards Committee, the Technical Working Group, the BAC Secretariat, the head of the Project Management Office or the end user or implementing unit, the procurement agent, and the project consultants, by consanguinity or affinity up to the third civil degree. It is understood that failure to faithfully disclose this relationship, or submission of beneficial ownership information containing false entries, is subject to blacklisting under Section 100 of the Implementing Rules and Regulations of Republic Act No. 12009, without prejudice to criminal and civil liabilities under applicable laws.
7. [Name of Bidder] complies with existing labor laws and standards.
8. [Name of Bidder] is aware of and has undertaken the responsibilities as a Bidder under the Philippine Bidding Documents, which includes:
   • a) Carefully examining all of the Bidding Documents;
   • b) Acknowledging all conditions, local or otherwise, affecting the implementation of the Contract;
   • c) Making an estimate of the facilities available and needed for the contract to be bid, if any; and
   • d) Inquiring or securing Supplemental Bid Bulletin(s) issued for the [Project Title].
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.
10. In case advance payment was made or given, failure to perform or deliver any of the obligations and undertakings in the contract shall be sufficient grounds to constitute criminal liability for swindling, or estafa, or the commission of fraud with unfaithfulness or abuse of confidence, through misappropriating or converting any payment received by a person or entity under an obligation involving the duty to deliver certain goods or services, to the prejudice of the public and the government of the Philippines, pursuant to Article 315 of the Revised Penal Code.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ____________, 20____ at ____________________, Philippines.

[Name of Affiant] · [Bidder's Representative or Authorized Signatory] · [Signatory's Legal Capacity] · Affiant

JURAT. SUBSCRIBED AND SWORN to before me this ____ day of ____________ at ____________________, Philippines. Affiant is personally known to me, and was identified through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC).

WITNESS MY HAND AND SEAL on the date and at the place first above written.

Doc. No. ______ · Page No. ______ · Book No. ______ · Series of ______