REPUBLIC ACT OF THE PHILIPPINES

PROVINCE OF _________________

I _____________(name)____________, Filipino, of legal age, designated as ______(position)_______ of

_______(name of organization)_______ with registered address located at
___________________________________ do certify the following:

 The FCAs has authorized the application for accreditation and has authorized the person
actually filing the application to represent the FCAs in the application.

 All supporting documents are authentic, true and correct.

 Neither the FCAs nor any of its member/members has been blacklisted by any GA.

 None of the members of the FCAs has been convicted in any case, or is currently a
defendant/accused/respondent in any pending case, related to the use of public Funds.

 The FCAs is aware of, understands, and agrees to abide by the guidelines for accreditation of
FCAs as beneficiary of RCEF.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS
ARE TRUE AND CORRECT.

(Signature Over Printed Name)

Designation/Date:

SUBSCRIBE AND SWORN to before me this ____ day of 2022, affiant has
satisfactorily proven his identity to me through his valid Identification No. _______________________,
with his/ her picture and signature appearing therein. That he/ she personally swears that he/ she
is the same person who personally signed the foregoing Sworn Certification before me and
acknowledged that he/ she executed the same.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2022.