Pledge of Restrictions on the Execution of Sole Source Contracts
• Please check [ √ ] the applicable items. (1page)
Orderer		Ordering agency				Department				Date
		Details of the Order										[ ] construction [ ] services [ ] products [ ] etc
		Reason(s) for a sole source contract
Contractor		Name				Organization						[ ] Individuals [ ] corporation [ ] Group [ ] etc
		Contact Info				Address
Check List of Restrictions Concerning the Execution of Sole Source Contracts
	Do you have any kind of following relationship with the high-ranking official of the ordering agency? him/herself, the spouse of him/her, the lineal ascendant and descendant of him/her, or the lineal ascendant and descendant of the spouse of him/her(only who shares a living with him/her)												[ ] YES [ ] NO [ ] N/A
②	Do you have any kind of following relationship with the public official actually/legally in charge of the contract? him/herself, the spouse of him/her, the lineal ascendant and descendant of him/her, or the lineal ascendant and descendant of the spouse of him/her(only who shares a living with him/her)												[ ] YES [ ] NO [ ] N/A
➂	Do you have any kind of following relationship with the member of the National Defense Committee of the Republic of Korea? him/herself, the spouse of him/her, the lineal ascendant and descendant of him/her, or the lineal ascendant and descendant of the spouse of him/her(only who shares a living with him/her)												[ ] YES [ ] NO [ ] N/A
➃	Does the representative of your agency or group fall under any categories from to ➂ ?												[ ] YES [ ] NO [ ] N/A
➄	Do you run a business entity which a person from to ➂ [him/herself, the spouse of him/her, the lineal ascendant and descendant of him/her, or the lineal ascendant and descendant of the spouse of him/her (only who shares a living with him/her)] owns or co-owns more than 30% of the total number of issued stocks, more than 30% of the total number of shares, or more than 50% of the total capital?												[ ] YES [ ] NO [ ] N/A
The company hereby submits this Pledge of Restriction on the Execution of Sole Source Contracts under Article 12 of The Act on the Prevention of Conflicts of Interest Related to Duties of Public Servants. Should it be found in the future that what is written in this form is untrue, the company confirms that it will accept any penalty as stipulated in the relevant laws and regulations. (Year) (Month) (Day)
Organization					Contractor				(Sign or Seal)
210mm×297mm[일반용지 60g/㎡(재활용품)]