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    Annex A Republic of The Philipines) CITY OF - ) S.S

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    Nina Anne Paracad
    This document is a sworn statement from a local chief executive affirming that: 1) There is a Sanggunian Resolution endorsing programs/projects for which funds are requested, including program titles. 2) The programs/projects will be implemented according to national government standards and policies. The local chief executive signs and dates the statement, which is then notarized. An annex provides contact details for the local chief executive and authorized project representative.

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    Download as DOCX, PDF, TXT or read online from Scribd

    Annex A Republic of The Philipines) CITY OF - ) S.S

    Uploaded by

    Nina Anne Paracad
    100 views2 pages
    This document is a sworn statement from a local chief executive affirming that: 1) There is a Sanggunian Resolution endorsing programs/projects for which funds are requested, including program titles. 2) The programs/projects will be implemented according to national government standards and policies. The local chief executive signs and dates the statement, which is then notarized. An annex provides contact details for the local chief executive and authorized project representative.

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    DBM SWORN STATEMENT

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    This document is a sworn statement from a local chief executive affirming that: 1) There is a Sanggunian Resolution endorsing programs/projects for which funds are requested, including program titles. 2) The programs/projects will be implemented according to national government standards and policies. The local chief executive signs and dates the statement, which is then notarized. An annex provides contact details for the local chief executive and authorized project representative.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    100 views2 pages

    Annex A Republic of The Philipines) CITY OF - ) S.S

    Uploaded by

    Nina Anne Paracad
    This document is a sworn statement from a local chief executive affirming that: 1) There is a Sanggunian Resolution endorsing programs/projects for which funds are requested, including program titles. 2) The programs/projects will be implemented according to national government standards and policies. The local chief executive signs and dates the statement, which is then notarized. An annex provides contact details for the local chief executive and authorized project representative.

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    © All Rights Reserved
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    Annex A

    REPUBLIC OF THE PHILIPINES )


    CITY OF ___________________ ) S.S.

    x------------------------------------------------x

    SWORN STATEMENT

    I, the undersigned, attest to the veracity of the following:

    i. There is a Sanggunian Resolution endorsing the following program(s) and/or


    project(s) for which the funds are requested:

    1. _______________________________________________
    2. _______________________________________________
    3. _______________________________________________
    (List down the requested program/project/activity title(s). The
    number of programs/projects/activities may vary depending on
    the request of the LGU.)

    ii. The said programs and/or projects shall be implemented in accordance with
    the standards and existing policies of the National Government.

    IN WITNESS WHEREOF, I have hereunto set my hands this ____ day of [month] [year] at
    [place of execution].

    [Insert NAME OF LOCAL CHIEF EXECUTIVE]


    [Insert Signatory’s Legal Capacity]
    Affiant

    SUBSCRIBED AND SWORN to before me this ____ day of [month] [year] at [place of
    execution], Philippines. Affiant is personally known to me and was identified by me 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 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 _____

    Page 1 of 1
    Annex B

    LGU CONTACT DETAILS

    Local Chief Executive


    Project Contact Person /
    Authorized Representative
    Designation in the LGU1
    Telephone No.
    Primary Mobile No.
    Secondary Mobile No.
    E-mail Address
    Address

    Approved by:

    [Name and Signature of Local Chief Executive]

    Note:

    The details provided herewith must be consistent with the details provided in the LGU
    identification cards of the Local Chief Executive and the LGU’s project contact
    person/authorized representative

    __________________
    1
    The project contact person/duly authorized representative must be an organic personnel of the LGU concerned.

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