REFERENCE NUMBER: __________

Republic of the Philippines

Department of Labor and Employment
BUREAU OF WORKING CONDITIONS
Labor Standards Review and Appealed Division

REQUEST FOR CERTIFICATION OF HAS/HAS NO PENDING CASE

(Please write legibly)

Name: _____________________________________________________________________
ContactNo.: _________________________________________________________________
Address: ___________________________________________________________________
Name if Company: ___________________________________________________________
Address of Company: _________________________________________________________
Purpose:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

___________________________
Signature
DATE:______________________

___________________________________________________________________________
(to be filled-up by the Action Officer)

Requirements submitted

( ) Letter Request
( ) Photocopy of the official receipt of the bidding fee(if for bidding purposes)
( ) Photocopy of any document showing that the DOLE CLEARANCE is being required
( ) Photocopy of DOLE Registration under Rule 1020; and
( ) Photocopy of DOLE Registration under D.O. 18-02,. If the requesting company is a contractor /
subcontractor.

Date/Time of completion of all requirements ________________________________________

Action Officer: ________________________________________________________________

--------------------------------------------------------------------------------------------------------------------------
CLAIM STUB
REFERENCE NUMBER:__________

The certification of has/or no pending case on appeal before the Office of the Secretary of
Labor and Employment shall be released on______________________,
to___________________________. Please present this stub to the Action Officer.

__________________
Action Officer