OMNIBUS UNDERTAKING

(SWORN AFFIDAVIT)

REPUBLIC OF THE PHILIPPINES)

CITY/MUNICIPALITY OF _________)S.S

AFFIDAVIT

Ernesto A. Catungal, of legal age, Married, General Manager ___________________, after

(Name of Applicant/Port Owner/Operation) (Civil Status) (Position/Title) (Name of Company/Address)

having been duly sworn in accordance with law, do hereby depose and state that:

1. I hereby apply for the Authority’s issuance of Permit to Operate (PTO) Security Services
(service/s to be provided)
at the Port of ____________.

2. As an applicant, I have full power and authority to do, execute and perform any and all
acts necessary to represent it in seeking from PPA the Permit to Operate being applied
(type of permit)
for.

3. I have complied and secured all the necessary government clearances/permits necessary
to operate my business.

4. I hereby authorize you duly authorized official/employee to verify the

statements/documents and information submitted herewith, to substantiate my eligibility
as an applicant for a PTO.

5. It is understood that I have complied with the requirements of other concerned

government agencies prior to the operation of the ancillary service being applied for and
I am fully responsible and accountable in complying with said requirements.

6. I hereby acknowledge that I have full knowledge of pertinent laws, regulations covering
ancillary service operation.

7. I hereby acknowledge that I have fully read the information supplied in the application
any false or misleading information provided therein shall be ground for the cancellation
of the PTO issued, without prejudice to the filling of appropriate administrative, civil
and criminal case against me and/or the company/entity I represent.

8. I hereby hold PPA free from all liens, encumbrances and liabilities resulting from non-
compliance therewith.

9. I am executing this Omnibus Sworn Statement to attest to the veracity of the foregoing
statements in support of the above-cited applicant.

IN WITNESS WHREOF, I have hereunto set my hand this ______day of _____, ______, in the
City of _____________________, Philippines.

ERNESTO A. CATUNGAL
(Ancillary Service Operator)

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

_________________
(Notary Public)

Doc.No._______
Page No. ______
Book No. ______
Series No. _____
 AFFIDAVIT OF ASSUMPTION OF RESPONSIBILITY
MASTERLIST OF TRANSPORT UNITS

I, ERNESTO A. CATUNGAL , of legal age, single/married and with postal address at 71 C-5 Road,
(name)

Bagong Ilog, Pasig City after having duly sworn to in accordance with law do hereby depose and
state that:

1. I am the General Manager, of Alcatraz Security and Investigation Agency, Inc.

(state position in the company) (name of company)

2. That _________________________is a legitimate port user engaged in

(name of company)
______________at
(services)
the port of _________________;

3. That said company/firm owns & operates the following transportation / trucking units
which had been issued valid registration, clearance, and permits and for which I assume
responsibility for their legitimate, safe and secure operations.

TYPE MAKE PLATE NO.

1. _____________________ _____________________ _____________________
2. _____________________ _____________________ _____________________
3. _____________________ _____________________ _____________________
4. _____________________ _____________________ _____________________
5. _____________________ _____________________ _____________________
6. _____________________ _____________________ _____________________
7. _____________________ _____________________ _____________________
8. _____________________ _____________________ _____________________
9. _____________________ _____________________ _____________________

4. That this Affidavit is being executed in support of our application for the issuance of
PPA Cargo Vehicle pass / Sticker for Calendar Year 2014.

ERNESTO A. CATUNGAL
Affiant

SUBSCRIBED AND SWORN to before me this _____day of _________201_, the herein affiant
exhibiting his Community Tax Certificate No. _______________issued at _______________ on
___________, 201_.

(Notary Public)

Doc.No._______
Page No. ______
Book No. ______
Series No. _____