AFFIDAVIT

REPUBLIC OF THE PHILIPPINES ) s.s.

_________________________________)

I, ___________________________________________________ of legal
age,
sing/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 re presentative 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 ______________________.
____________________________
Signature over printed name
of affiant