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New Regular Contractor's License Application (Sole Proprietonhlp)

PCAS-F-SVD-001a. Revision No. 00, 11/19/2018
This Form Is NOT for sale. Reproduction Is Allowed
Page4of4

STE AFFIDAVIT OF CONSTRUCTION EXPERIENCE

Note; To be accom lished b the NEWLY nominated STE._Pl�ase use additional sheets if necessa
Republic of the Philippines )
Province of �""'"�.,;.,���{
City/Municipality of '(tC
r,..: S.S
1, REYNOLD P. NINI single/married, Filipino, of legal age, with postal address at BRGY MAPANG, RIZAL,
ZAMBOANGA DEL NORTE, having been duly sworn in accordance with law depose and say that the projects
enumerated below constitute my full & comolete construction exoerience.
Name and Work NatuNISoope of Work Profect Duration
Complete Addrns or l!mployarl Cl■Hlflcatlon Anlgnment (mm/dd/yyyy)
Name & Location of Pn,jeota Undertaken (GE, GB, SP) (Proj. Eng{.)
From To
),,/ LC CONSTRUCTION GB PROJECT
(-) (o�owi fl ?J r\l� ,SGW1)\ 1fv.(\J.WW1, (GENERAL ENGINEER
JAN JUNE
14'\-fl.l"'""', 'i,,.v-.',o� tA� �4 BUILDING)
13, 30,
:i.-)(o,o\t\tcAI"-� rJ 1,. s� SJ.,.,o\ ,�'!>, 2020 2023
uo� 1,0<....,1:,°'"V"°I_, d,c.\ \loA�
@)) LONG ISLAND BUILDERS
l·) �c,l\'o"' tJ.. �- �... �, DEC 31,
,�. �1M-'P6'-"')"- �;� 2019
'l.=) (.,.,sm,.� o,\ 1- ¼lo<(. fu..-�, GE(GENERAL PROJECT MARCH
�"' 1 2,,.� on� <>.J... No(\<, ENGINEERING) ENGINEER 2,2015

That I authOrlze the PCAB to verify and 1nvest1gate any or all information 1n this affidavit from whatever sources
PCAB may consider appropriate;
That I am executing this affidavit to attest to the truth of the foregoing.

FURTHER AFFIANT S.AYETH NAUGHT.

lnlng Technical Employee (STE)

(Signature over Printed Name)

SUBSCRIBED AND
20.22_ at exhibited
his/h unity on
�

NOTARY PUBLIC
Until December 31,
20!.z_

Doc. No ?-�
Page No. 5/1
Book No. Y.f/
Series of 20 ,z..
AMO must sign here: