<Name of Agency>

<Address>

<Name of Union>

SWORN STATEMENT ON POSTING AND RATIFICATION OF

COLLECTIVE NEGOTIATION AGREEMENT (CNA)

I, <Name>, of legal age, <single/married>, and Secretary of the <Name of Union>,

<Name of Agency>, <City/Municipality, Province>, after having been sworn to in
accordance with law, hereby depose and state:

That the Collective Negotiation Agreement (CNA) entered into by and between the
<Name of Union> and the management of the <agency> was signed on <date of signing of
CNA>;

That the signed CNA was posted for at least seven (7) calendar days from
_____________ to ____________ at the following conspicuous places (indicate the places where it
was posted; should be posted at 2 conspicuous places);

That the signed CNA was ratified by majority of the rank-and-file employees in the
negotiating unit on < date/s of ratification>; and

That attached herewith is Annex _______ bearing the names and ratifying signatures
of majority of the rank-and-file employees in the negotiating unit and made integral part of
this document.

Done this _________ day of _________________________, <City/Municipality, Province>.

Signature over Printed Name

Secretary, <Name of Union>

Attested by:
Signature over Printed Name
President, <Name of Union>

SUBSCRIBED AND SWORN to before me this _________________________________ in

__________________________________________________ by the above-named person who exhibited
to me his/her <valid ID> issued on ________________________________ at
__________________________________________________.

Doc. No. : ___________

Page No. : ___________
Book No. : ___________
Series of _____________