Republic of the Philippines

COMMISSION ON AUDIT
Office of the Auditor
Department of Labor and Employment
City of San Fernando, La Union
Tel. No. (072) 607-91-58

Auditor's Declaration of Independence and Compliance

with Relevant Ethical Requirements
(Individual Declaration Form)

As [team member/team leader/supervisinq auditor], I am part of the audit group/team of [name of the
agency] that will conduct the following audit(s) for [period coveredl:

Financial Audit
Performance Audit: [Audit topic]
Compliance Audit: [subject matter]
Other Assurance engagement: (please specify)

A. Declaration of Independence and Compliance with Relevant Ethical Requirements

For the purpose of this audit, I declare that, to the best of my knowledge (please put a check mark ‘✓’
on the box):

I do not have relatives within the fourth civil degree of consanguinity or affinity who are directors,
officers or holding financial reporting functions in the auditee;

I, or any members of my family within fourth civil degree of consanguinity or affinity, do not have
any business relationships with or financial interest in the auditee or any of
its directors, officers and employees that would compromise my independence;

I have not been previously employed with the auditee within the last five years; and

I have not received in the past and will refuse any benefits, gifts, gratuities or preferential treatment
from persons employed by or associated with the auditee that would compromise my independence
and objectivity.

In addition:
 I will not provide any professional service to the entity relating to the financial information being
audited or related to management responsibilities or power that would compromise my
objectivity

 I will perform the audit with highest degree of excellence and professionalism and in accordance
with applicable auditing standards;

 I will perform the audit with honesty, integrity, impartiality and political neutrality;
  I will exercise due professional care in conducting/supervising the audit and in preparing the
audit reports;
 I will protect the confidentiality of information obtained during the audit process and will not
disclose such information to third parties, unless the law or an appropriate court requires me to do
so; and
 I will abide with the provisions of Rule Ill of the Revised Code of Conduct and Ethical Standards
for Commission on Audit (COA) Officials and Employees prescribed per COA Resolution No.
2018-010 dated February 1, 2018 and I understand that non-compliance with the provision shall
partake of the nature of an administrative offense under the Civil Service Law.

B. Circumstances which may impair my compliance with the above statements: (Please provide separate
sheet as necessary)

B.2: Business interests in the auditee

B.3: Previous employment with the auditee

B.4: Other circumstances

I hereby certify that I understand the requirements and responsibilities of the above statements and that I
have provided complete details of the circumstances which may compromise my compliance. I also
acknowledge that I am responsible in making timely written notification in the event that any other
circumstances arise during the audit period that may affect compliance with this declaration.

Signature over printed name Date: ________________

Positions (SAE 11/SA IV/SA V)
Designation (SA/ATL/ATM)
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 CONCLUSION ON COMPLIANCE WITH
INDEPENDENCE AND RELEVANT ETHICAL REQUIREMENTS

Based on my knowledge and belief, and after considering the results of my interview and validation of the
declared statements of [indicate name of the audit team member/ATl (SA, I conclude that there are no
indicators of non-compliance with the requirements. Any existing conditions that may impair compliance
with independence and ethical requirements have been eliminated or reduced to an acceptable level as
follows:

Risks of Non-Compliance Disposition/ Safeguards

Signature over printed name Date: _________________

Assistant Cluster or Assistant Regional Director/
Supervising Auditor/Audit Team Leader
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