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Application Form For Certificate of Exemption

This document is a request form for a certificate of exemption from Philippine labor laws. It collects personal information about the applicant such as name, nationality, contact details, and position. It also requests details about the type of exemption being sought, which includes categories for diplomatic personnel, international organization staff, and foreign nationals in specific jobs or economic zones. The applicant must declare that the information provided is true and acknowledge they will abide by Philippine laws.

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Johann Benedict Borromeo
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190 views2 pages

Application Form For Certificate of Exemption

This document is a request form for a certificate of exemption from Philippine labor laws. It collects personal information about the applicant such as name, nationality, contact details, and position. It also requests details about the type of exemption being sought, which includes categories for diplomatic personnel, international organization staff, and foreign nationals in specific jobs or economic zones. The applicant must declare that the information provided is true and acknowledge they will abide by Philippine laws.

Uploaded by

Johann Benedict Borromeo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

ANNEX A
DEPARTMENT OF LABOR AND EMPLOYMENT
REGIONAL OFFICE NO.______

REQUEST FORM FOR CERTIFICATE OF EXEMPTION

Please supply all required information. Misrepresentation1, false statement or fraud in this application or in any supporting document is ground
for denial/ revocation/cancellation of the certificate.

I. TYPE OF APPLICATION: [ ] NEW [ ] EXTENSION

II. PERSONAL DATA


Name: _____________________________________________________________________________________
(Last name) (First name) (Middle name)
Nationality: ____________________________________________ Sex: _______ Marital Status: ______________
Date of Birth: ________________________________ Place of Birth: ____________________________________
( DD / MM / YYYY )
Passport No.: ___________________ Place of Issuance: __________________ Issuance Date: _____________
( DD / MM / YYYY )
Expiration Date: ______________________ Visa: _______________________ Visa Validity:_________________
( DD / MM / YYYY ) ( DD / MM / YYYY )
Address in the Philippines: _____________________________________________________________________
Contact Number: ____________________________ E-Mail Address: ___________________________________
Permanent Address Abroad: ____________________________________________________________________

III. DETAILS OF EXEMPTION/CATEGORY:

1. Dependent spouse of any member of the Diplomatic corps, provided there is an existing reciprocity agreement
and/or exchange of notes between the Philippine Government and their respective countries of origin.

2. Accredited officials and personnel, including their dependent spouse, of international organizations of which
the Philippine Government has entered into an agreement with.

3. Officers, staff, and employees working in the Embassy by reason of extra-territoriality principle.

4. Officers and staff of Peacekeeping or International Organizations, either deployed in the Philippines or invited
by Non-Governmental Organizations as accredited, endorsed or certified by the appropriate government
agencies, provided they will not engage in any gainful employment in the Philippines.

5. Foreign nationals who come to the Philippines to teach, present and/or conduct research studies in
universities and colleges as visiting, exchange or adjunct professors under formal agreements between the
universities or colleges in the Philippines and foreign universities or colleges; or between the Philippine
government and foreign government, subject to rules of reciprocity.

6. Permanent resident foreign nationals and probationary or temporary resident visa holders

7. Refugees and Stateless Persons recognized by the Department of Justice (DOJ).

8. Foreign Nationals granted exemption by law


8.1 Economic Zone Charter (indicate the name of economic zone authority: _______________________)
8.2 International School (indicate the name of the school: _____________________________________)
8.3 Other (please specify: _____________________________________________________________)

Position: __________________________________________________________________________________
Brief Job Description: ________________________________________________________________________
_________________________________________________________________________________________

Name of Philippine-based Company: ____________________________________________________________


Business Address: ________________________________________________________________
Contact Number: ____________________________ E-Mail Address: __________________________________
Nature of Business/Industry: (Please refer at the back)
√
A[ ] B[ ] C[ ] D[ ] E[ ] F[ ] G[ ] H[ ] I[ ] J[ ] K[ ]

L[ ] M[ ] N[ ] O[ ] P[ ] Q[ ] R[ ] S[ ] T[ ] U[ ] N/A [ ]

IV. DECLARATION: I declare that the statements made in this application are true and correct to the best of
my knowledge and belief and I will abide by the Philippine laws, rules and regulations.

____________________________________ ______________________
Name and Signature of the Applicant Date

1
Misrepresentation of facts in this application includes fraudulent misrepresentation i.e., false statement that has a negativ e effect in the evaluation of the application
made knowingly, or without belief in its truth, or recklessly whether it is true or false.
NATURE OF BUSINESS / INDUSTRY
A Agriculture, Forestry, and Fishing

B Mining and Quarrying

C Manufacturing

D Electricity, Gas, Steam, and Air Conditioning Supply

E Water Supply, Sewerage, Waste Management and Remediation Activities

F Construction

G Wholesale and Retail Trade; Repair of Motor Vehicles and Motorcycles

H Transportation and Storage

I Accommodation and Food Service Activities

J Information and Communication

K Financial and Insurance Activities

L Real Estate Activities

M Professional, Scientific, and Technical Activities

N Administrative and Support Service Activities

O Public Administration and Defense; Compulsory Social Security

P Education

Q Human Health and Social Work Activities

R Arts, Entertainment, and Recreation

S Other Service Activities

T Activities of Households as Employers; Undifferentiated Goods


Services-Producing Activities of Households for Own Use
U Activities of Extraterritorial Organization and Bodies

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