By: XYZ CONSTRUCTION Contract No. ______________________
Contractor Address: 123 Sampaguita St., Tacloban City
This ______ day of ___________________, 2018 affiant personally appeared before
me, a Notary Public, being by me first duly sworn/affirmed, states that all materials meet or exceed the specifications of the Contract and that all suppliers of labor and materials have been paid all sums due them for work performed or materials furnished in the performance of the Contract between the City of Tacloban, Leyte, Owner, and XYZ Construction, Contractor, dated ______________________, 2018,for the construction of _______________________________ project or arrangements have been made by the Contractor satisfactory to such suppliers with respect of payment of such sums as may be due them by the Contractor.
By: Mr. Cardo Dalisay
Contractor/Proprietor XYZ CONSTRUCTION
SUBSCRIBED AND SWORN TO before me this _____ day of ________, 2018 in
___________, Affiant Exhibiting to me his __________________ issued on ______________________ in______________________ , Philippines.
Doc No. : __________
Page No. : _________ Book No. : _________ Series of 2018.