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Anti-Graft Certificate

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ANTI-GRAFT CERTIFICATE

I, _________________________________________________________________, of
legal age, President/General Manager of ______________________ with postal address at
___________________________________________________ after having been duly sworn,
depose and say:

That pursuant to the provision of Section 3 and 14 of R.A. 30l9 (Anti-Graft Act), the
applicant enterprise ________________________________________
has not given or promised to give, and will not give, any gift to any officer or employee of the
Philippine Economic Zone Authority in connection with the filing and processing of this
application, nor will it give such gift to any of said officers or employees after approval of its
application.

That based on the records of the applicant, no Director or Officer of the Philippine
Economic Zone Authority has an investment or other financial interest, direct or indirect, in the
applicant; and

That this certificate was made with the approval of applicant’s Board of Directors.

_________________________________
Affiant

Republic of the Philippines )


)S.S.

City/Province of _________________________________
Subscribed and sworn to before me this ________ day of __________, l9____ in the
City/Province of ___________________________________________
_____________________________________________. Affiant exhibit to me his Residence
Tax Certificate No. __________________ issued at
_____________________________________ on _______________________________,
l9_________.
__________________________________
Notary Public

Doc. No. _____________


Page No. _____________
Book No._____________
Series of l9____________

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