Republic of the Philippines)

City of ) S.S.

AFFIDAVIT

I, ____________, Filipino, of legal age, with office address at_______________________, having been
sworn in accordance with law, depose and state that:

1. I am the <indicate position/designation> of <indicate PEZA-registered company name> (the

“Company”).

2. The Company will be disposing/selling <unused or used (choose one or both, as applicable)>,<indicate
quantity and description, e.g. 200 units of IT and non IT equipment> from <indicate IT Center
facility/location> which are company-owned assets and that the disposition of the same has been
authorized by the responsible company officials;

3. The items to be disposed are <obsolete or defective (choose one or indicate both, as applicable)>,
<imported or locally purchased (choose one or indicate both, as applicable)> and <more than or less
than five (5) years in age (choose one or indicate both, as applicable)> from the date of acquisition;

4. The Company shall ensure full compliance with all applicable laws, rules and regulations pertaining to
the transport, disposition and treatment of hazardous wastes, as may be applicable;

5. The disposition of subject goods will not result in the reduction of the company’s production capacity
and/or company’s workforce, and the Company will continue to meet its investment commitment with
PEZA;

6. <Company name> has informed all creditors and all third parties affected, if any, of the subject
sale/disposition of assets;

7. The Company renders PEZA and BOC free and harmless from any and all damages, liabilities/claims by
third parties including other government agencies that may arise from this transaction.

IN WITNESS WHEREOF, I hereunto affix my signature this ____ day of ____ 2018 at _______,
Philippines.

Name of Signatory
Position

Before me, a notary public in and for the city named above, personally appeared:
Name Competent Evidence of Identity Date &Place of Issue

Name of signatory ID#

who was identified by me through competent evidence of identity to be the same person who presented the instrument
hereto annexed and signed the instrument in my presence, and who took an oath before me as to such instrument.

Witness my hand and seal this ___ day of _____, 2018.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 20168