PCAB FORM

PCAB-PAD-REN-F01
Page 1 of 2
Effectivity Date 02/08/2013
Revision No. 03
This Form is NOT for sale. Reproduction is Allowed

SUSTAINING TECHNICAL EMPLOYEE AFFIDAVIT

Note: Please accomplish this affidavit properly. Refer to the next page for STE qualification requirements.

Republic of the Philippines )

Province of ______________)
City/Municipality of ________) S.S
Last Name

I,

First Name

Tendido

Born on
and
residing at:

dd

01

Ext. Name (Jr/Sr, if any)

Restituto
mm

10

yyyy

Single /
Married to

1970

Middle Name

De Lara
Last Name

First Name

Tendido

Angelita

Middle Name

Moncayo

Room/Floor/Unit/Bldg. Name, Lot/Block/Phase No., Street, Subdivision, Barangay, City/Municipality, Province, Zip Code

Blk. 15 Lot 20 Wodsite 3 BahayangPag- Asa Subdivision, Imus Cavite

having duly sworn to in accordance with law depose and say:

1.

That I am a duly licensed Civil and holder of PRC License No. 67619

valid up to October 01, 2015.

(PROFESSION)

That I hold a Bachelor's Degree in

2.
Given at:
3.

4.

Name of School

Technological Institute of the Philippines

162-613-598
and my Social Security System Number:
33-3471534-3

6.
7.
8.
9.
10.
11.

Given on:

Inclusive Dates

1992

That my Tax Identification Number is :

That I am employed on a regular and full-time

basis by:
With position of

5.

Course / Profession

Civil Engineering

Name of Firm

St. Clara International Corporation

Position in the Firm

as a STE for

Project Manager

CFY

2016-2017

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;
That I am not a holder of a valid contractor's license;
That I am not involved in any construction malperformancesuggestive of negligence, incompetence or malpractice or any
act or omission liable for disciplinary action by myself or in collaboration with any other person;
That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude;
That I am fully aware that my failure to notify the PCAB of my disassociation with my present employer shall cause my
disqualification to be a Sustaining Technical Employee or an Authorized Managing Officer or an applicant for a contractors
license with PCAB;
That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB may
consider appropriate;
That I am executing this affidavit to attest to the truth of the foregoing.

FURTHER AFFIANT SAYETH NAUGHT.

Restituto D. Tendido
Affiant

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 ___

PCAB FORM
PCAB-PAD-REN-F01
Page 2 of 2
Effectivity Date 02/08/2013
Revision No. 03
This Form is NOT for sale. Reproduction is Allowed

SUSTAINING TECHNICAL EMPLOYEE AFFIDAVIT

Note: Please accomplish this affidavit properly. Refer to the next page for STE qualification requirements.