DO 174 SEMI ANNUAL For Contractors Rev00

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Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT


Regional Office No. XI

CONTRACTORS/SUB-CONTRACTORS SEMI ANNUAL REPORT

Period Covered

Business Name : _______ TIN: ________________________


Business Address : ____________________________________________________ Contact No.: _______________
Nature of Business : _________________________________________________ Registration No.: ______________
Areas of Operation : _________________________________________________ Regist’n. Expiration: ____________
Contact Person and Position: ______________________________________________ Contact No.: _______________
Number of Workers Involved for six (6) months: ______ Male: _______ Female: ________ Total: ___

Name and Address of Client/Principa] Services Provided to the Position o( Personnel Number of Personnel
Nature of Business Client/Principal Assigned to the Per Position
Client/Principal Male Female

UNOERTAKING:

That I, Filipino, of legal age,


Name Civil Status Position

of after having been duly sworn to in accordance with law, do


hereby depose and say;

1. That our company have abided all applicable laws and regulations of the Department of Labor and
Employment;
2. That the remittances to SSS, HDMF, Philhealth, ECC and BIR have been paid religiously by the company;
3. That all above data are true and correct

In witness whereof, I have hereunto affixed my signature this _____ day of ________ 20______
in ______________________________________, Philippines.

Affiant’s Name/Signature

SUBSCRIBED AND SWORN to before me this . Affiant exhibited to


me his/her Residence Certificate No. , issued at _____________on___________________.

Doc. No.
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Book No.

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