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FORM NO.

LETTER OF INTENT (LOI) AND APPLICATION FOR ELIGIBILITY

(Date of Issuance)

Commissioner
Bureau of Customs
Port Area, Manila

Attention : Deputy Commissioner Gregorio B. Chavez


Chairman
Committee on the Accreditation of Service Provider (CASP)

Dear Sir / Madame:

I hereby express my intention to apply for eligibility pursuant to CAO No. 4-


2010 as implemented by CMO 24-2010 to become a Customs Electronic GPS-
Equipped Barrier Seal Service Provider (CEGBSSP). The company which I
represent is committed to undertake the following:

1. To supply the required number of Customs Electronic GPS-Equipped


Barrier Seals (CEGBS) to be installed on containers carrying transit cargo;
2. To provide the appropriate hardware, software and application system for
the tracking and monitoring of transit cargo installed with CEGBS;
3. To establish a network of competent personnel deployed in designated
customs ports to handle the attachment and removal, maintenance,
transport, and security and ensuring availability of CEGBS units
4. To provide training to BOC personnel and its partner agencies in the
monitoring and tracking of CEGBS installed transit cargo as well as in the
audit of historical transit data;
5. To deliver all the services detailed in the Invitation to Apply for Eligibility.

I hereby certify that all information provided herein, is true and correct, and I
hold myself liable, criminally or civilly, for any misrepresentation or false statement
made herein.

Very truly yours,

Name, Position and Signature of Authorized Signatory

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Form No. 2

REPUBLIC OF THE PHILIPPINES)


MANILA ) S.s.

AFFIDAVIT OF NON-INCLUSION IN THE BLACKLIST

I, (name and designation of authorized signatory), Filipino, of legal age and


(address), after having sworn in accordance with law hereby deposes and states
that:

1. I am the (designation) of (name of applicant corporation), as shown by a


Secretary’s Certificate which is hereto attached;

2. (name of the company) is an applicant as Customs Electronic GPS-Equipped


Barrier Seal Service Provider (CEGBSSP) with the Bureau of Customs
pursuant to Customs Administrative Order No. 04-2010 and Customs
Memorandum Order No. 24-2010;

3. (name of the company) is not included in the blacklist of contractors for any
government projects including its subdivisions or was included in the
Consolidated Blacklisting Report issued by the Government Procurement
Policy Board (GPPB). Attached herewith is the certification from the GPPB;
and

4. I am executing this Affidavit to attest to the truth of the foregoing facts and in
compliance with the eligibility requirement as Customs Electronic GPS-
Equipped Barrier Seal Service Provider (CEGBSSP).

AFFIANT FURTHER SAYETH NAUGHT.

Mr. X
Affiant

SUBSCRIBED AND SWORN to before me this __ day of January 2011, in


Manila.

NOTARY PUBLIC

Doc. No.
Page No.
Book No.
Series of 2011

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Form No. 3

LIST OF ONGOING & COMPLETED UNDERTAKINGS (2007-2010)

Name of Company: _____________________________________


Business Address: _____________________________________

A. On-going Undertakings
Name of Inclusive Description of Amount of Project
Project Dates Service/s Being
Provided

* For the above list, attached copy of contract

B. Completed Undertakings

Name of Inclusive Description of Amount of Project


Project Dates Service/s Provided

* For the above list, attached copy of Certificate of Satisfactory Completion issued by
the client

Submitted by:

Printed Name, Position & Signature of Authorized Signatory

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FORM NO. 4

STATEMENT ON TECHNICAL COMPETENCE AND EXPERTISE OF OFFICERS /


PERSONNEL

Date of Issuance

Commissioner
Bureau of Customs
Port Area, Manila

Attention : Deputy Commissioner Gregorio B. Chavez


Chairman, Committee on the Accreditation of Service Provider (CASP)

Dear Sir/Madame:

In compliance with the requirements of the Bureau of Customs CASP for eligibility to
be accredited as Customs Electronic GPS-Equipped Barrier Seal Service Provider
(CEGBSSP), we certify to the technical competence, experience and expertise of the
following officers/personnel, hereunder enumerated:

Name Educational Attainment Years with Firm Age


1.
2.
3.
4.
5.
n.

Attached are their respective bio-data.

Very truly yours,

Name, Position and Signature of Authorized Signatory

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FORM NO. 5

LETTER OF AUTHORITY TO VALIDATE SUBMITTED DOCUMENTS

Commissioner
Bureau of Customs
Port Area, Manila

Attention : Deputy Commissioner Gregorio B. Chavez


Chairman, Committee on the Accreditation of Service Provider (CASP)

Dear Sir/Madame:

In compliance with the eligibility requirements of the Bureau of Customs CASP for
accreditation as Customs Electronic GPS-Equipped Barrier Seal Service Provider
(CEGBSSP), we hereby authorize the CASP or its authorized representative/s to
verify the statements, documents and information submitted herewith to substantiate
our eligibility.

The following persons, including telephone/fax numbers may be contacted to provide


further information with regard to this application:

Name Telephone No. Fax No.

1. ___________________________________________________________
2. ___________________________________________________________
3. ___________________________________________________________

Very truly yours,

Name, Position and Signature of Authorized Signatory

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FORM NO. 6

AFFIDAVIT OF AUTHENTICITY

I, ___(Representative of the Company)___, of legal age, __(civil status)__, Filipino


and residing at ___(Address of the Representative)_, under oath, hereby depose
and say:

1. That I am the __(Position in the Signatory)__ of the ___(Name of the


Company)___, with principal office address at ___(Address of the Company)___;

2. That each of the documents submitted is original copy or certified true copy
and that all statements and information contained therein are true and correct;

3. That this affidavit is being executed to attest to the truth of the foregoing and
in compliance with the eligibility requirement of __(Name of the Company)__ for
qualification as Customs Electronic GSP-Equipped Barrier Seal Service Provider
(CEGBSSP).

IN TRUTH WHEREOF, I hereby affix my signature this _____ day of _____, 20___
at _____________, Philippines.

___________________________________
Name, Position & Signature of Authorized Signatory

SUBSCRIBED AND SWORN TO before me this _________, day of ______ 2003,


affiant exhibiting to me his/her (Passport or any valid ID) No. ________________
issued on _________ at _____________________, Philippines.

(Notary Public)

Doc. No.
Page No.
Book No.
Series of 2011

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