Renewal of Regular Contractor’s License Application (Sole Proprietorship)
PCAB-F-SVD-002a. Revision No. 00, 11/19/2018
This Form is NOT for sale. Reproduction is Allowed
Page 16 of 24
SUSTAINING TECHNICAL EMPLOYEE (STE) AFFIDAVIT OF UNDERTAKING
Note: Please accomplish this affidavit properly. Refer to the next page for STE qualification requirements.
2x2 Picture
Republic of the Philippines ) of STE
Province of ______________)
City/Municipality of ________) S.S
Last Name First Name Ext. Name (Jr/Sr, if any) Middle Name
I,
mm dd yyyy Single / Last Name First Name Middle Name
Born on Married to
Room/Floor/Unit/Bldg. Name, Lot/Block/Phase No., Street, Subdivision, Barangay, City/Municipality, Province, Zip Code
and
residing at
Telephone / Mobile No. (required) Email Address (required)
with
having been duly sworn in accordance with law depose and say:
1. That I am a duly licensed ____________________________________________ and holder of PRC License No. __________
(Profession)
valid up to _______________, as evidenced by a copy of my PRC ID posted below;
Course / Profession
That I hold a Bachelor's Degree in
2. Name of School Inclusive Dates
Given at: Given on:
That my Tax Identification Number is :
3.
and my Social Security System Number:
That I am employed on a regular and full-time Name of Firm
basis by:
4.
Position in the Firm Contracting Fiscal Year (CFY)
With the position of as STE for
20___ - 20___
5. That I am not presently employed by either a private company or any government office or government owned/controlled
corporation, nor a full time instructor, nor working abroad;
6. That I am not a holder of a valid contractor's license;
7. That I am not involved in any construction malperformance suggestive of negligence, incompetence or malpractice or any
act or omission liable for disciplinary action by myself or in collaboration with any other person;
8. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude;
9. That I am fully aware that my failure to notify the PCAB of my disassociation from my present employer within 30 days from
such disassociation shall cause my disqualification from being a Sustaining Technical Employee, an Authorized Managing
Officer and an applicant for a contractor’s license with PCAB;
10. That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB may
consider appropriate;
11. That I am executing this affidavit to attest to the truth of the foregoing.
FURTHER AFFIANT SAYETH NAUGHT.
_____________________________
Sustaining Technical Employee (STE)
(Signature over Printed Name)
SUBSCRIBED AND SWORN to before me this _____ day of ___________________, 20___ at ___________________________;
affiant exhibited his/her Community Tax Certificate No. _____________ issued at __________________ on ______________ 20___.
Doc. No. NOTARY PUBLIC
Page No. Until December 31, 20 ___
Book No.
Series of 20 ___
-PASTE HERE- -PASTE HERE-
ACTUAL SIZE clear copy of ACTUAL SIZE clear copy of
valid PRC ID CARD valid PRC ID CARD
(Front) (Back)
AMO must sign here:
