Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Samar Field Office

CERTIFICATE OF CHANGE OF NAME

OF WORKERS’ ASSOCIATION

Registration Certificate No.: <ISSUED REGISTRATION NO.>

KNOW ALL MEN BY THESE PRESENTS:

Pursuant to the provisions of Presidential Decree No. 442, as amended, and it’s
implementing rules and regulations, the <FORMER NAME OF THE WORKERS’
ASSOCIATION>, granted legal personality as a workers’ association with Registration Number
indicated above on the ___ day of <Month yyyy> after having complied with the requirements for
notice of change of name, is now hereby registered as:

<NEW NAME OF THE WORKERS’ ASSOCIATION>

<Address of the Workers’ Association>

Accordingly, it shall have all the rights and privileges of a legitimate workers’
association, including the right of succession to any rights, privileges, or responsibilities
as may have been enjoyed or incurred under its former name.

This Certificate of Registration shall subsist unless cancelled in the manner

provided by law.

IN WITNESS WHEREOF, I have hereunto affixed my signature, with the seal of

the Department of Labor and Employment at <City/Province>, Philippines, this ___ day
of <Month yyyy>.

<NAME OF APPROVING AUTHORITY>

<Designation>