COMPANY NAME

ADDRESS
CONTACT NUMBER

CERTIFICATE OF (ELECTRICAL/MECHANICAL/ELECTRONICS) SYSTEM SAFETY AND

CONFORMITY

Inspection performed at:

Building Name
Address

Name of Company:
Company Name

Scope of work:
(Electrical/Mechanical/Electronics) System Inspection

Date Conducted:
Month Day, Year

As per inspection results of (Electrical/Mechanical/Electronics) System to the extent of

(Electrical/Mechanical/Electronics) works and installations, this certifies the safety and
conformity of (Electrical/Mechanical/Electronics) System in accordance with the requirements of
the Philippine (Electrical/Mechanical/Electronics) Code.

Professional (Electrical/Mechanical/ Authorize Representative

Electronics) Engineer Company Name

PTR. No.:
Date Issued:
PRC Reg. No:
Date Issued:
TIN:
Address: