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I hereby declare under oath that:

1. This Data Sheet has been accomplished by me, and is a true, correct and complete statement

pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the

Philippines.

2. I have disclosed all information relevant to my application/appointment in a GOCC Governing

Board.

3. I have all the qualifications and none of the disqualifications of an Appointive Director.

4. Neither I nor any person or organization that I am affiliated with is engaged in any transaction

or activity that may represent a conflict with my possible appointment in a GOCC Board.

5. I will promptly inform the Governance Commission of any situation/affiliation/business relations

constituting and/or could give rise to a conflict of interest.

I HrR=ev wAtvE THE coNFlDENTtALtry oF THE tNFoRMATtoN oN THts Dnrn SHEer AND AUTHoRtzE THE

GCG ro rHoRoucHly TNVESTTcATE THE sAME tN RELATToN To My sutrABtlrry FoR GOCC

DIRECToRSHIP.

1211212M6LEONCIO B. EVASCO, JR.

Cabinet Secretary and PCA Chairman

MMIDD/YYYY SIGNATURE

SUBSCRIBED AND SWORN To BEFoRE ME,

EXHTBITED To ME (Hrs/H=n) Corvrrr,rur'trw Tax

ON AND BY

Corrruururrv Tnx CrnrrrrcRre No.

CrRrrrcRrE No.

WHO

TSSUED AT

WHO

ISSUED AT

EXHTBTTED ro ME (nrs/nrn)

ON

NOTARY PUBLIC

DOC. NO.

PAGE NO.

BOOK NO.

SERIES OF