AFFIDAVIT

REPUBLIC OF THE PHILIPPINES ) s.s.

_________________________________)

I, ___________________________________________________ of legal
age, single/married, residing at _________________________________________,
after being sworn in accordance with law, depose and say that:

1. I am an applicant for (state the permit, registration, certification, ECC

being applied for) pursuant to (cite the relevant section no./provision of applicable
RA, DAO or IRR);

(if the applicant is a representative of the company or partnership or a

juridical entity, the applicant should state that he has been granted the authority to
apply for such document)

2. I am aware and understand all the duties, responsibilities and

accountability to be imposed upon me and (my company) by such application and
as such will be liable for all the damages incurred and for any untoward incident
during its actual operation;

3. I attest to the truth, accuracy and genuineness of all the information,

documents and records contained and attached to this application and that I (and
my company) shall be liable for any misrepresentation, fraudulent declaration and
all its consequences;

4. That the vehicle(s) are solely/exclusively use in transporting hazardous

wastes; and

5. I am executing this affidavit as a proof of good faith in complying with

the requirements for securing the abovementioned (permit, registration, certificate,
ECC).

IN WITNESS WHEREOF, I have hereunto set my hand this _______day of

___________________ 20__ in ______________________.

____________________
Affiant