MANGAY-AYAM, LIM AND CO.

CERTIFIED PUBLIC ACCOUNTANTS

Client-Company:
Period:

Independence Checklist (Code of Ethics)

Directions:
This form is to be accomplished for all clients.

Yes No Remarks
(indicate N/A if
Not Applicable)
Based on appropriate enquiries performed, we are not aware of any
relationships (financial, business, family, personal or employment)
between the client and the firm and its partners and staff, which
could impair our independence.
We are not aware of any matters related to the provision of non-
audit services to the client, which could impair or be seen to impair
our independence.
Does the client owe the firm any significantly overdue fees?
Is there any actual or threatened litigation between the firm and the
client?
Has the lead audit engagement partner complied with the rotation
requirements on the audit engagement?
Are we aware of any other situations, which could impair the firm’s
independence?
Have any benefits been received by any member of the audit team
that are not clearly “modest” (including receipt of hospitality, goods
and services)?
Are the fees for both audit and non-audit services material to either
the firm or the engagement partner?

Non-Audit Services

SEC Memo 13 Series of 2009 states that an SEC accredited auditing firm shall not engage in any of the non-
audit services for its statutory audit clients unless the safeguards under the IFAC Code of Ethics are
undertaken by the firm to reduce the threat to its independence.

Non-audit services Safeguards implemented Fees

Bookkeeping services
Financial information system
design and implementation
Appraisal or valuation services,
fairness opinions, contribution-in-

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 MANGAY-AYAM, LIM AND CO.
CERTIFIED PUBLIC ACCOUNTANTS
Client-Company:
Period:

Independence Checklist (Code of Ethics)

kind reports
Actuarial services
Internal audit outsourcing
services
Management functions or human
resources
Broker or dealer, investment
adviser, or investment banking
services
Legal services and other
professional services unrelated to
audit

Conclusion:
a) The Audit Team has complied with the Independence Policies in accordance with the IFAC Code of
Ethics for Professional Accountants and other relevant ethical standards.
b) Adequate safeguards are in place to eliminate any threats or reduce them to an acceptable level and
we are independent and our objectivity has not been compromised.

Prepared by: Date: Reviewed by: Date:

Engagement Date: Quality Date:

Partner: Assurance
Reviewer:

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