For Micro Business Enterprises

ATTESTATION AND UNDERTAKING

I hereby certify and attest that:

1. I am the owner or authorized representative of [Company Name], with office address at

___________________;

2. As the owner or authorized representative of [Company Name], I have full power and
authority to execute and perform any and all acts necessary to apply for, sign and
execute the ensuing contract for the Quezon City Wage Relief Subsidy Program;

3. That [Company Name] complies with existing labor laws and standards;

4. That [Company Name] does not have any outstanding or pending open cases with the
Bureau of Internal Revenue (BIR);

5. That [Company Name] does not have any pending cases with the Department of Labor
and Employment (DOLE);

6. All information included in the application form is true and complete to the best of my
knowledge;

7. All information, including the documents submitted shall be the basis of the assessment
of our Company’s eligibility for the Quezon City Wage Relief Subsidy Program;

8. In the event that any of the information or documents provided are false and/or
fraudulent, the Company shall reimburse any and all amounts received plus legal
interest without prejudice to the filing of any criminal, civil or administrative suit against
me and the responsible officers of my Company.

9. By signing below, I hereby give my consent to the processing of my personal and

business data for purposes of applying for the stimulus package. This is for purposes of
compliance with the Data Privacy Act of 2012.

__________________________________
[OWNER/ REPRESENTATIVE’S SIGNATURE
ABOVE PRINTED NAME]
 ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF METRO MANILA ) SS
CITY OF QUEZON )

SUBSCRIBED AND SWORN to before me this ____day of [month] [year] at [place of

execution], Philippines. Affiant/s is/are personally known to me and was/were identified by me
through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M.
No. 02-8-13-SC). Affiant/s exhibited to me his/her [insert type of government identification card
used], with his/her photograph and signature appearing thereon, with no. ________ and his/her
Community Tax Certificate No. _______ issued on ____ at ______.

Witness my hand and seal this ___ day of [month] [year].

NAME OF NOTARY PUBLIC

Serial Number of Commission ____________

Notary Public for _________until _________
Roll of Attorneys No. ___________________
PTR No. _____________________________
IBP No. ______________________________

Doc No
Page No.
Book No.
Series of 2020.