ERD.2.F.

003

Name of Enterprise: ___________________________ ANNEX A

Zone Location: ___________________________________________

List of New/Additional Machines and Equipment for _________ Project

Under Registration/Supplemental Agreement with PEZA dated ____________

Particulars on Importation / Local Purchases

PEZA Permit Issued* Name of Supplier / Address of Supplier / Invoice of Supplier / Source*
Description Type of Permit PEZA PEZA Permit Source of Equipment Source of Equipment
of Qty. Issued (8101, Permit No. Date No. Cost**
Machines/ 8105, 8112, Date
Equipment others)

*Please attach copy of PEZA permits issued and invoices of suppliers/sources

**Please indicate value in US$ or foreign currency per invoice and the equivalent in PhP

No. of workers: Direct (production): _______ Line Supervisors: _______Indirect/Admin.: _______ Management _______
No. of seats: _____________ (for I.T. enterprise only)

We certify: (a) that the above-listed machines/ equipment are the complete equipment being used for ___(name of company)_____’s _____(specify
project)_____________ ; (b) to the completeness and accuracy of the above information; (c) that _____(name of company)______ acquired above listed
machinery/equipment specifically for the above-subject project; and, (d) that _________(name of company)______ is the original owner in the Philippines of the
above-listed machinery-equipment and that the same had not been previously used by ____(name of company other than for the above-subject project nor
by any other manufacturing enterprise in the Philippines. Further, said machines/equipment have been: (Please check appropriate box)
[ ] Consigned by _(name& address of consignor)__ [ ] Purchased [ ] Leased from _(name & address of lessor)__

________________________ ____________________
Signature/Date Signature/Date

________________________________ ________________________________
Name/Designation of Enterprise Official Name/Designation of Enterprise Official

Validated and Attested by:

________________________________ ____________
PEZA-Zone Administrator/Manager/OIC Date

Validation of machines/equipment for confirmation of ITH entitlement and application for ITH extension under CELR criterion