Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. ___

PERMIT TO OPERATE INTERNAL COMBUSTION ENGINE

(This permit is valid only upon payment of inspection fee and expires one-year from date of inspection unless otherwise revoked)

ICE No. Date of Inspection:

Pursuant to Article 165, Chapter II, Book IV of the Labor Code of the
Philippines (LCP), as amended and its implementing rules and regulations.
Rule 1180 of the Occupational Safety and Health (OSHS), as amended, it is
hereby certified that herein described internal combustion engine,
inspected by the duly authorized representative of the Department of Labor
and Employment has been found to be in condition safe for operation.
Name of Owner/User
Address
Manufacturer or Brand Name
Bore and Stroke
No. of cylinders and cycles
Revolution per minute
Kind of drive
Horsepower Rating
Weight of Engine
Kind of ICE

Inspection Fee P
Official Receipt No.
Date

Regional Director
(Please post this permit in a conspicuous place enclosed in a glass frame and accessible
to all concerned inspecting authority)