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Omnibus Undertaking

PPA omnibus undertaking for private port permits

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(SWORN AFFIDAVIT)

REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF _______ ) S.S.

AFFIDAVIT

(Name of Applicant/Port Owner/Operator), of legal age, (Civil Status), (Position/Title, (Name of
Company/Address), after having been duly sworn in accordance with law, do hereby depose and
state that;
1. I hereby apply for the Authority’s issuance of (type of Private Port Application) to be located at
(Address of the Proposed Port Site).
2. As port applicant/port owner/operator /duly authorized representative of the company, I have
full power and authority to do, execute and perform any and all acts necessary to represent it
in seeking from PPA the corresponding (type of private port permit) being applied for.
3. I have complied and secured all the necessary government clearances/permits necessary to
operate my business.
4. I hereby authorize your duly authorized official/employee to verify the statements/documents
and information submitted herewith, to substantiate my eligibility as an applicant for a private
port permit.
5. It is understood that I have complied with the requirements of other concerned government
agencies prior to the operation of the private port and I am fully responsible and accountable
in complying with said requirements.
6. I hereby acknowledge that I have full knowledge of pertinent law, regulation covering private
port operation.
7. I hereby acknowledge that I have fully read the information supplied in the application and any
false or misleading information provided therein shall be a ground for the cancellation of the
clearance to develop, permit to construct and certificate of registration/permit to operate
issued, without prejudice to the filing of appropriate administrative, civil and criminal action
against me and/or the company/entity I represent.
8. I hereby hold PPA free from all liens, encumbrances and liabilities resulting from noncompliance therewith.
9. I am executing this Omnibus Sworn Statement to attest to the veracity of the foregoing
statements in support of the above-cited application.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of _______, ___, in the City
of ________________, Philippines.

_____________________________
Private Port Owner/Operator

SUBSCRIBED AND SWORN to before me this _______ day of _________.

________________________
(Notary Public)
Doc. No. _______
Page No. ______
Book No. ______
Series of ______
 
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