CIAP Change of A M O 04Feb11 by rNnlqGw

VIEWS: 8 PAGES: 5

									                                                                                                                                  PCAB
                                                                                                                    F    PCAB-PAD-CMO-F01
                                         CHANGE OF AUTHORIZED MANAGING                                              O    Revision     00
                                                                                                                    R    Eff. Date   11/8/2010
                                              OFFICER APPLICATION                                                   M                 1 of 5
                                                                                                                         Page
                                                                    REQUIRED ITEMS
The following pertinent documents and information shall be submitted in support of Change AMO of PCAB license application.(Applicant may Initially fill
out the check boxes subject for final validation by PCAB/DTI-ROG pre-screener)
A. LEGAL




In behalf of ____________________________________________________________________________
                                          (Name of Firm)
holder of Contractor’s License No. ________, originally issued on ______________ and last renewed during
the CFY 20__ - 20__ , I hereby request for change of Authorized Managing Officer (AMO) as follows:
                                Name                                                         Nationality
From :        ____________________________________                                 ________________________________
To      :     ____________________________________                                 ________________________________
I hereby certify to the completeness of the information/documents contained in this application
appertaining to the category/classification the company is applying for and that they are true and correct.
I am fully aware that:
1. all documents submitted in support of this application are subject to verification before PCAB action;

2. any discovered misrepresentation of information and/or manifestations of fraud on the application
   documents submitted by my firm applicant or its Authorized Representative/Agent/Liaison Officer shall
   be subjected to investigation which may result to the disapproval of my application,
   denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized
   Managing Officer; and

3. unconfirmed information/documents submitted to support my firm's qualifications will be excluded
   for categorization/classification purposes.

                                                                                _______________________________
                                                                                   Authorized Managing Officer
                                                                                  (Signature over Printed Name)
Republic of the Philippines )
Province of ______________)
City/Municipality of ___________) S.S


SUBSCRIBED AND SWORN TO before me this ________ day of ___________________ 20____ at
______________________; affiant exhibited to me his Community Tax Certificate No. _______________
issued at __________________ on _________________ 20 ___.


Doc. No.
Page No.
Book No.
Series of 20 __.                                                              NOTARY PUBLIC
                                                                     (Until December 31, _______)
                                                                                                                          PCAB
                                                                                                           F     PCAB-PAD-CMO-F01
                                                                                                           O     Revision     00
                                                                                                           R     Eff. Date   11/8/2010
                                                                                                           M     Page         2 of 5


For Corporations or Associations with foreign shareholders, the following documents shall be submitted:
1. Corporate Secretary’s Certification as follows:
               a. List of stockholders showing their nationalities and shareholdings; and
               b. List of Board of Directors showing their names and nationality.
2. Copy of latest General Information Sheet duly filed with SEC showing the names of stockholders and directors, nationality and
   shareholdings.
         The percentage control of the number of seats occupied by foreigners in the Board of Directors shall not exceed 40%.


                                                                                                                               Complied
CHECLIST OF REQUIREMENTS:                                                                                               Yes      No      N/A

        1. AMO Nomination / Original Corp. Secretary's certificate as to the                                            [ ]      [ ]      [ ]
           nomination of the AMO(Page 4 of 5);
        2. AMO Affidavit (Page 3 of 5) with a passport size picture of AMO;                                             [ ]      [ ]      [ ]

        3. Original NBI Clearance of Filipino Authorized Managing Officer (AMO) and                                     [ ]      [ ]      [ ]
           non-Filipino AMO who has resided in the Philippines for six (6) months or longer;
        4. Certified true copy of NBI Clearance Equivalent for non-Filipino AMO/RAR                                     [ ]      [ ]      [ ]
           duly authenticated by the Phil. Embassy in the home country of the AMO/RAR;

        5. Original copy/certified true copy by the BID of the Alien Certificate of Registration (ACR)                  [ ]      [ ]      [ ]
          & valid working visa.

        6. Certified copy latest General Information Sheet submitted to SEC. (for corporations                          [ ]      [ ]      [ ]
           only)
          Note: Photo/xerox copies of documents may be submitted provided that original
                  documents are Presented for comparison to PCAB.
D. OTHERS
   D.1. Original Signature of AMO on each and every page of the application forms including
         Supporting documents.                                                                                           [ ]      [ ]     [ ]
   D.2 The Board may require the AMO interview and submission of pertinent documents/information
        other than the above in order to fully determine the qualifications of the applicants;                           [ ]      [ ]     [ ]
   D.3 New AMOs’/Applicants shall be required to take the AMO Examinations except category
                                                                                                                         [ ]      [ ]     [ ]
       TRADE applicants.
  D.4 Self-stamped envelopes (One self stamped mailing envelope is required for each
                                                                                                                         [ ]      [ ]     [ ]
        supporting document submitted.)
   D.5 Applicants interested to participate in government projects should accomplish
         Application for Registration and Classification of Government Projects(PCAB-PAD-ARC-                            [ ]      [ ]     [ ]
         F01) and file the same together with the PCAB Application Form.
   D.6 Accomplished Affidavit for Firm’s Authorized Representatives                                                      [ ]      [ ]     [ ]

FOR PCAB/ DTI-ROG USE ONLY

  No. of Pre-                          Prescreening Results                                     Filed              Pre-screener / Date
  screening
  1st           [ ] Comply lacking items as listed in the Remarks   [ ] Accepted   [ ] PCAB Makati [ ] DTI-ROG
  2nd           [ ] Comply lacking items as listed in the Remarks   [ ] Accepted   [ ] PCAB Makati [ ] DTI-ROG
  3rd           [ ] Comply lacking items as listed in the Remarks   [ ] Accepted   [ ] PCAB Makati [ ] DTI-ROG



REMARKS:
LETTER / ITEM NO.      COMMENTS:
                                                                                                           PCAB
                                                                                             F    PCAB-PAD-CMO-F01
                                                                                             O    Revision     00
                                                                                             R    Eff. Date   11/8/2010
                                                                                             M    Page         3 of 5
AMO AFFIDAVIT

                                                                                                           Recent Photo
 Republic of the Philippines )
 Province of ______________       )                                                                        Passport Size
 City/Municipality of ___________            ) S.S.

               SURNAME                   FIRSTNAME                            MIDDLE NAME
 I,
               DD      MM      YYYY      Single / Married    SURNAME          FIRSTNAME                MIDDLE NAME
 Born on
                                         to
                       ST. # & NAME      BARANGAY           DISTRICT     CITY/MUNICIPAL      PROVINCE         ZIPCODE
 and residing at:
 Having duly sworn in accordance with law depose and say:
    1. That I am the Authorized Managing Officer of :
         ________________________________________________________________________________
         (Name of firm)
    2. That I possess the following educational attainments (attach additional sheet if necessary)
          NAME OF SCHOOL                        ADDRESS                           COURSE                INCLUSIVE DATES




       3. That I possess at least two (2) years experience in the construction industry as follows (Ref. Sec. 20 of
          IRR of R.A. 4566) (attach additional sheet if necessary)
      DESIGNATION /       COMPANY / NATURE                                                              DATES OF
                                                      ADDRESS              JOB DESCRIPTION
        POSITION            OF BUSINESS                                                                EMPLOYMENT




       4. That I possess knowledge of the building, safety, health , & lien laws of the Republic of the Philippines
          & the rudimentary administrative principles of construction contracting from my work experiences in item 3
          above and from the following training/seminars (Ref. Sec. 20 of IRR of R.A. 4566):
       5. That I am not involved in any construction malperformance suggestive of negligence, incompetence or
          malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other
          person (Section 4.2 of IRR of R.A. 4566)
       6. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude
          (Rule (Section 4.2 of IRR of R.A. 4566)
       7. That I am fully aware that my failure to notify PCAB of my disassociation with my present employer shall
          cause my disqualification to be an Authorized Managing Officer, a Sustaining Technical Employee or a
          license applicant with PCAB .
       8. That I authorize the PCAB to verify and investigate any or all information in this instrument from whatever
          sources PCAB may consider appropriate
          That I certify under pain of perjury that all information on this affidavit are true and correct.
      FURTHER AFFIANT SAYETH NAUGHT.
                                                                 _________________________________
                                                                               Affiant
      SUBSCRIBED and sworn to before me this _____ day of _________________, 20___ affiant exhibited his/her
      Community Tax Certificate No. __________ issued at _____________________ on ________________.


      Doc. No.
      Page No.
      Book No.                                                           NOTARY PUBLIC
      Series of 20__                                                         Until December 20__
                                                                                                      PCAB
                                                                                         F   PCAB-PAD-CMO-F01
                                                                                         O   Revision     00
                                                                                         R   Eff. Date   11/8/2010
                                                                                         M   Page         4 of 5
SECRETARY’S CERTIFICATION (for Corporation/Cooperatives only)

 Republic of the Philippines )
 Province of _____________ )
 City/Municipality of ________) S.S

             SURNAME                  FIRSTNAME                           MIDDLE NAME
 I,
                    ST. # & NAME      BARANGAY          DISTRICT     CITY/MUNICIPAL      PROVINCE        ZIPCODE
 and residing at:

 do hereby certify, in my capacity as the duly elected and incumbent Corporate Secretary of
 ______________________________________________________________________________
 (Name of firm)
                                                 DD MM YYYY Held             CITY / MUNICIPALITY OF MEETING
 That during its regular meeting held on
                                                                     at

 Wherein a quorum was present , the following resolution was unanimously approved, to wit:



                                              AMO NOMINATION


             "R E S O L V E as it is hereby resolved that

             _______________________________________________________________________,
                    (FIRSTNAME               MIDDLENAME                  SURNAME)

             a senior executive who has been granted the power to render general management and
             administrative decision, be appointed as the firm's Authorized Managing Officer to act on
             all matters concerning the requirements of the PCAB and implementation of R.A. 4566 as
             amended by P.D. 1746."




 In WITNESS WHEREOF, I have hereunto affixed my hand this ___________ day of ______ 200___, in

 ______________________________, Philippines.


                                                            _________________________________
                                                                  Corporate Secretary
                                                                    (Signature Over Printed Name)



 SUBSCRIBED and sworn to before me this ________ day of _______ 20___ affiant exhibited to me his/her

 Community Tax Certificate. No. ____________ issued on _____________ at ________________________.



 Doc. No.
 Page No.
 Book No.
 Series of 20 __.                                               NOTARY PUBLIC
                                                              Until December 20 ____
                                                                                            PCAB
                                                                               F   PCAB-PAD-CMO-F01
                                                                               O   Revision     00
                                                                               R   Eff. Date   11/8/2010
AFFIDAVIT OF REPRESENTATIVE                                                    M   Page         5 of 5




Republic of the Philippines )
Province of _____________ )
City/Municipality of ________) S.S


        I, _______________________________, of legal age, Filipino, married/single with postal
address at ____________________________________, after having been sworn to in accordance
with law, hereby depose and say:

         1. That I am the Proprietor/Authorized Managing Officer (AMO) of
            ______________________________________________________________________;
                                                  (Name of Firm)

         2. That I appoint ____________________________, whose picture and signature appear
            below, to transact business with PCAB; i.e., present for pre-screening my application for
            contractor’s license or any application related thereto, file/follow-up, submit documents,
            receive notices/license in connection with the said application and the like.



                                                      Representative Signature over printed
                  Passport Size Photo
                      Most Recent
                 Taken within the last six            Address: _______________________
                months prior to application
                    of PCAB license                   _______________________________



         3. That I am aware that I am responsible/liable for any or all acts/representation made by my
 Type of Application: (Pls. check)
            representative in connection with the functions stated herein.
  New
  Upgrading
       4.
  RenewalThat I undertake to notify PCAB in the event that this appointment is modified, amended or
            revoked.
  Others, pls. specify
   _______________________



                                                    ______________________________________
                                                                      AFFIANT
                                                        (Authorized Managing Officer of Firm)


SUBSCRIBED and sworn to before me this ______ day of ____________, 20___, affiant exhibited
his/her Community Tax Certificate No. _______________ issued at ___________ on
___________________.

   Type of Application: (Pls. check)
    New
    Upgrading                                                         NOTARY PUBLIC
   Type of Application: (Pls. check)
     Renewal
  Type of Application: (Pls. check)                                   Until December 20 ____
     New
   New
    Upgrading (Pls. check)
 TypeOthers, pls. specify
      of Application:
  New
   _______________________
    Upgrading
      Renewal
  Upgrading
     Others, pls. specify
  Renewal
      No.
Doc. _______________________
   Renewal
  Others, specify
Page No. pls. specify
   Others, pls.
  _______________________
    _______________________
Book No.
Series of 20 __.

								
To top