Republic of the Philippines

Department of Labor and Employment

Establishment Registration

(Please indicate address as reflected in the business permit)

Total number of workers must match.


Valid government-issued photo ID includes Philippine Passport, Driver's License, SSS UMID Card, PhilHealth ID, Postal ID, TIN Card, Voter's ID, PRC ID

This is to certify the accuracy of data provided in this registration form.


Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Intramuros, Manila

ESTABLISHMENT REPORT

A. Establishment Data
Name of Establishment:
Floor/Bldg/No/Street/Subdivision:
Barangay/City/Municipality:
Kind of Business/Economic Activity/Principal Product:
Number of Workers:
Male: Managerial:
Female: Supervisory:
Rank and File:
Total: Total:

CERTIFICATION

This is to certify as to the accuracy of the data provided in this report.

Name and Signature of Owner/Company Representative:
Designation:
Fax No:
Contact No:
Email Address:


Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Intramuros, Manila

LIST OF AFFECTED WORKERS DUE TO COVID-19

No. Name of Worker Birthdate Sex Home Address Contact No. Designation Employment Status Salary