CONSULTANT`S PREQUALIFICATION FORM

Date : January 1, 2000

Name of Firm :
Date Established : jan 1, 2000 Country : Manila, Philippines
Type of Organization : Individual Partnership Corporation Others...

Affiliated Firms :
Date Established : jan 1, 2000 Country : Manila, Philippines
Type of Organization : Individual Partnership Corporation Others...

Home Address :
Business Address :
Cable Address :

Former Consultant`s Name :

Date Established Firm Ownership : jan 1, 2000

Narrative Description on Firms ( Use other sheet if necessary ) :

KEY PERSONNEL OF FIRM : ( See attached curriculum vitaes for more information )
YEARS W/
NAME AGE POSITION DEGREES FIRM

99 Y.O. 99999

NAME OF 2 PRINCIPALS TO CONTACT: ( Listed principals must be empowered to speak for the firm on policy &
contractual matters )

NAME POSITION CONTACT NUMBER

( 02 ) 123-45-67 / 890- 12-34 / 567-89-01
0910-123-45-67
Number of Personnel in present organization:

TECHNICAL : Number of Employees

a. Civil Engineers
b. Structural Engineers
c. Electrical Engineers
d. Mechanical Engineers
e. Architects
f. Economist
g. Others ... ( Specify )

ADMINISTRATIVE STAFF :

a. Secretary

Total no. of personnel : 0

Annual volume of gross fees ( last 5 years ) : P

BANK REFERENCE :

BANK NAME ADDRESS

FIELDS OF SPECIALIZATION TYPE OF SERVICES ( A, B, C, D, E )

1. ENGINEERING
2. ARCHITECTURE
3. FINANCE
4. MANAGEMENT
5. AGRICULTURE
6. LAW
7. OTHERS...

A - Advisory & Review Services D - Construction Supervision

B - Pre-investment or Feasibility Studies E - Other Technical Services or Special Studies
C - Design
Projects handled by the consultant for the last five years :

PRIME JOINT
PROJECT NAME YEAR CONSULTANT VENTURE SERVICE RENDERED CLIENT NAME & ADDRESS INDEX FEE

RANGES OF PROFESSIONAL FEES INDEX :

A - Less than P100,000 E - P 1 Million to P 2 Million
B - P 100,001 to P 250,000 F - P 2 Million to P 5 Million
C - P 250,001 to P 500,000 G - P 5 million to P 10 Million
D - P 500.001 to P 1 Million H - P 10 Million or Greater
Typical projects for which consulting services have been furnished by the consultant.
( Reference sheets may be submitted for as many projects as desired ) :

Name of overall project :

Location of overall project :

Consultant`s Fee :

Owner :

Address :

Year services Completed :

( Indicate if estimated or actual associated firms )

Description of Project :

Description of Services Firm provided :

List types of services for associated aspects of overall project :

List of Equipment, Instrument, & Vehicles of Consultant ( Owned & Leased ) :

NAME DATE PURCHASED or LEASED COST

I certify that the information in the above Prequalification Form are true to the best of
my knowledge.

PRESIDENT

SUBSCRIBED AND SWORN to before me this day of , at

, affiant having exhibited to me his / her Residence Certificate Number :
issued at on , .

Doc. No.
Page No.
Book No. Notary Public
Series of 2000 Until December 31, 2000