Affidavit Of Disclosure i4j1r

REPUBLIC OF THE PHILIPPINES ) CITY OF DAVAO ) s.s x------------------------x

AFFIDAVIT OF DISCLOSURE

I ________________________________, Filipino of legal age, married and a resident of _____________________________________________, after having been duly sworn to in accordance with law, hereby depose and say: 1. That I am an applicant for a certificate of registration with the Department of Labor and Employment to operate as job/service contractor/subcontractor under the business name __________________________________________, with business address at ___________________________________________ and duly ed with the Department of Trade and Industry/Securities and Exchange Commission. 2. That said _______________________________________________________ is not a "Labor-only" contractor and/or agency as defined under Article 106 of the Labor Code of the Philippines since it has capital or investment in the form of tools, equipment or machinery and the workers placed therein are not performing activities which are directly related to the main business of its principal or client. 3. That said _____________________________________________________ will undertake and/or provide services, works or jobs as it may contract from individuals, companies, or other entities, public or private and will abide with all applicable labor laws, rules and regulations. 4. Sworn disclosure that the registrant, its Officers and Owners or principal stockholders have not been operating or previously operating as a contractor under different business name or entity; the list of clients, if any, the number of personnel assigned to each client, if any, and the services provided to the client. 5. That I am executing this affidavit to attest to the truth of the foregoing facts. IN WITNESS WHEREOF, I have hereunto set my hand this ___________ day of __________________, 20______ in the City of ______________________, Philippines.

___________________________________ Affiant CTC No. ___________________________ Issued at ___________________________ Issued on ___________________________

SUBSCRIBED AND SWORN to before me this _______ day of _____________ 20______ in the City of _________________________, Philippines.