Republic
of the Philippines )
City
of (Place) )
S.S.
AFFIDAVIT
OF CONTINUOUS COMPLIANCE
I, (NAME OF AFFIANT), of legal age,
Filipino, single/married, and a resident of (Place of Residence), after having been sworn to in accordance with
the law hereby voluntarily depose and state:
1. That as
a (Name of Profession), I am the (Position in Establishment) of (Name of Establishment) with business
address at (Place);
2. That
prior to the renewal of our establishment’s license to operate an (Name of Facility) for the year (Year), I am faithfully, religiously,
and completely complying with the licensing requirements of the (Name of Government Agency);
3. That by
virtue of this sworn statement, I manifest to the (Name of Government Agency) that our facility is continuously
complying with the licensing requirements to ensure (add details);
4. That if
the enforcement team of the (Name of
Government Agency) conduct monitoring/inspection of our facility and it is
found to have deficiencies, I shall be liable for any sanction to be imposed by
the (Name of Government Agency)
pursuant to the law and it Implementing Rules and Regulations;
5. That
this affidavit releases the (Name of
Government Agency) of any legal liability in connection with the renewal of
our license to operate;
6. That I
am executing this affidavit as a requirement for the renewal of our license to
operate an (Name or Type of
Establishment).
IN
TRUTH WHEREOF, I have hereunto signed my name below, this (Date) at (Place),
Philippines.
(NAME
OF AFFIANT)
SUBSCRIBED
AND SWORN to before me, this (Date)
in (Place), Philippines affiant
exhibiting to me his (ID Details),
valid until (Date) and issued at (Place), Philippines.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.
