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Application Form For Certificate of Exclusion

The document is a request form for a certificate of exclusion from mandatory Philippine labor market testing. It requests information such as the applicant's name, nationality, position, and employer details. The applicant declares that the provided information is true and correct. The form distinguishes between new applications and extensions, and lists different categories of exclusion including intra-corporate transferees, contractual service suppliers, and representatives of foreign employers.

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Johann Benedict Borromeo
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1K views

Application Form For Certificate of Exclusion

The document is a request form for a certificate of exclusion from mandatory Philippine labor market testing. It requests information such as the applicant's name, nationality, position, and employer details. The applicant declares that the provided information is true and correct. The form distinguishes between new applications and extensions, and lists different categories of exclusion including intra-corporate transferees, contractual service suppliers, and representatives of foreign employers.

Uploaded by

Johann Benedict Borromeo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT


ANNEX B
REGIONAL OFFICE NO.______

REQUEST FORM FOR CERTIFICATE OF EXCLUSION

Please supply all required information. Misrepresentation1, false statement or fraud in this application or in any supporting document is ground
for denial/ revocation/cancellation of the certificate.

I. TYPE OF APPLICATION: [ ] NEW [ ] EXTENSION

II. PERSONAL DATA


Name: _____________________________________________________________________________________
(Last name) (First name) (Middle name)
Nationality: ____________________________________________ Sex: _______ Marital Status: ______________
Date of Birth: ________________________________ Place of Birth: ____________________________________
( DD / MM / YYYY )
Passport No.: ___________________ Place of Issuance: __________________ Issuance Date: _____________
( DD / MM / YYYY )
Expiration Date: ______________________ Visa: _______________________ Visa Validity:_________________
( DD / MM / YYYY ) ( DD / MM / YYYY )
Address in the Philippines: _____________________________________________________________________
Contact Number: ____________________________ E-Mail Address: ___________________________________
Permanent Address Abroad: ____________________________________________________________________

III. DETAILS OF EXCLUSION/CATEGORY:

1. Member of the governing board with voting rights only and does not intervene in the management
of the corporation or in the day to day operation of the enterprise.

2. President and part-owner

3. Treasurer and part-owner

4. Intra-corporate transferee who is a manager, executive or specialist and an employee of the


foreign service supplier for at least one (1) year prior to deployment to a branch, subsidiary, affiliate
or representation office in the Philippines.

5. Contractual service supplier who is a manager, executive or specialist and an employee of a


Foreign Service supplier which has no commercial presence in the Philippines.

6. Representative of the Foreign Principal/Employer assigned in the Office of Licensed Manning


Agency (OLMA).

Position: __________________________________________________________________________________
Brief Job Description: ________________________________________________________________________
_________________________________________________________________________________________

Name of Philippine-based Company: ____________________________________________________________


Business Address: ________________________________________________________________
Contact Number: ____________________________ E-Mail Address: __________________________________
Nature of Business/Industry: (Please refer at the back)
√
A[ ] B[ ] C[ ] D[ ] E[ ] F[ ] G[ ] H[ ] I[ ] J[ ] K[ ]

L[ ] M[ ] N[ ] O[ ] P[ ] Q[ ] R[ ] S[ ] T[ ] U[ ] N/A [ ]

IV. DECLARATION: I declare that the statements made in this application are true and correct to the best of
my knowledge and belief and I will abide by the Philippine laws, rules and regulations.

____________________________________ ______________________
Name and Signature of the Applicant Date

1
Misrepresentation of facts in this application includes fraudulent misrepresentation i.e., false statement that has a negativ e effect in the evaluation of the
application made knowingly, or without belief in its truth, or recklessly whether it is true or false.
NATURE OF BUSINESS / INDUSTRY
A Agriculture, Forestry, and Fishing

B Mining and Quarrying

C Manufacturing

D Electricity, Gas, Steam, and Air Conditioning Supply

E Water Supply, Sewerage, Waste Management and Remediation Activities

F Construction

G Wholesale and Retail Trade; Repair of Motor Vehicles and Motorcycles

H Transportation and Storage

I Accommodation and Food Service Activities

J Information and Communication

K Financial and Insurance Activities

L Real Estate Activities

M Professional, Scientific, and Technical Activities

N Administrative and Support Service Activities

O Public Administration and Defense; Compulsory Social Security

P Education

Q Human Health and Social Work Activities

R Arts, Entertainment, and Recreation

S Other Service Activities

T Activities of Households as Employers; Undifferentiated Goods


Services-Producing Activities of Households for Own Use
U Activities of Extraterritorial Organization and Bodies

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