PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

(GOVERNMENT SERVICE INSURANCE SYSTEM)

GSIS Bldg., Financial Center, Pasay City 1308

Vendors/Suppliers Registration Information Sheet

Registered Company Name:

Registered Business Address:
Contact Person/Representative:
E-mail Address:
Business Tel. No.:
G-EPS Registration Number:
SEC Registration Number:
DTI Registration Number:
Website (if any): TIN:
Business Fax. No.: Nature of Business:
G-EPS Expiration Date:
SEC Registration Date:
DTI Registration Date:

TO BE FILLED-UP BY MMS

Date of Filing: Date of Expiration: MMS Control Number:

Remarks:
Received by: Date Received:

Attachments: Affidavit – “ANNEX A”

GEPS Certification
BIR Form 2303 (Certificate of Registration)
Current Mayor’s Permit
C:/My Documents/MMD FIles/Registration Information Sheet
“ANNEX A”

AFFIDAVIT

I, ___________________________, single/married, of legal age, Filipino and residing at

___________________________________________________ as the
______________________________ of ____________________________________
with business address at ___________________________________________________
having duly sworn to in accordance with law do hereby depose and say:

1.) That, _____________________________________ is not blacklisted

nor barred from bidding by the government or any of its agencies,
offices, corporations or local government units (LGU), nor included in
the Consolidated Blacklisting Report issued by the Government of the
Philippines.

2.) That, all the owner/s, officers and directors of this Company are not
related within the 3rd degree of consanguinity or affinity to the GSIS
Head of Procuring Entity or to employee/s having direct access to
information that may substantially affect the result of the bidding.

3.) That each of the documents submitted in satisfaction of the eligibility

requirements is an authentic and original copy, or a true faithful and
complete reproduction or copy of the original and that all statements
and information provided therein are true and correct.

IN FAITH WHEREOF, I hereby affix my signature this ____ day of ____, ______ at
______________________.

_____________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ______ day of __________, _____,

affiant exhibiting to me his/her Community Tax Certificate No. _______________ issued
on _____________________ at __________________, Philippines.

Doc. No. _______________

Page No. _______________
Book No. _______________
Series of _______
NOTICE to new vendors/suppliers who would like to become a
registered GSIS vendor/supplier, Please fill up all the details
required in page 1. The affidavit shall be accomplished by the
President or Corporate Secretary for Corporation and the Owner
for a single proprietor company and duly NOTARIZED.
Accomplished forms and attachments shall be submitted to the
Materials Management Department, Level 1, Core B, GSIS
Headquarters Bldg, Financial Center, Pasay City.

To ALL registered vendors/suppliers, please renew/update your

registration every year by submitting the Business Permit for the
current year and valid PhilGEPS registration.

For further inquiries call us at Telephone No. 8590318 and look for
Jojo Roaquin.

Materials Management Department