CENTURY PEAK CEMENT MANUFACTURING CORPORATION

17th Floor, Philamlife Tower, Paseo de Roxas, Makati City

Tel. No. (632) 856-0999 Fax No. (632) 8564844

ACCOUNTABILITY FORM
(For Company Property / Equipment)

Form No.
Name and I.D. No.
Area Head
Department

Co. Property/Equipment
Model/Control No. Serial No.
Description

Other Remarks

ACKNOWLEDGMENT

I hereby acknowledge that I have received the above-described company

property/equipment in good and serviceable condition specifically for use at the
job site, and that the same is in my personal custody. I accept full responsibility
over the same, with the specific undertaking that I shall keep the said
property/equipment in a safe and proper place while same is in my custody. I
am fully aware that should said company property/equipment be stolen,
damaged or otherwise rendered unserviceable, I am mandated, under duty, to
provide a direct written report to my immediate superior/supervisor and/or plant
manager, and failure on my part to do so shall be taken as an infraction of
company rules and regulations against me. I likewise acknowledge and accept
that any such damage/loss of said company property/equipment resulting from
misuse/neglect/carelessness, while the same remains in my custody, shall be
charged against me.

I hereby declare that upon the end of my employment, I shall return all company
property/equipment in as good and serviceable condition as when I received the
same. Failing which, the company is authorized to withhold my final payment
and clearance of dues. I likewise hereby authorize the company to deduct any
such item of damage/loss from my final pay.

By signing below, I hereby acknowledge having received the Accountability Form

and accept its terms and conditions.

Signature

Date

Supervisor Signature