PD851 Compliance Report Form

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Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT


Regional Office No. III
San Fernando Pampanga

REPORT ON COMPLIANCE WITH P.D. NO. 851

1. Name of Establishment : _______________________________________________

2. Address : _______________________________________________

3. Principal Product of Business : _______________________________________________

4. Total Employment : _______________________________________________

5. Total Number of Workers Benefited: _______________________________________________

6. Amount Granted per Employee : _______________________________________________

7. Total Amount of Benefits Granted : _______________________________________________

8. Name of person giving information : _______________________________________________

Positon : _________________________________________

Tel. No. : _________________________________________

_____________________________
Owner / Manager

NOTE:

1. Amount and payment of 13th month pay. The minimum 13th month pay required by P.D. 851 as
amended should not be less than one twelfth (1/12) of the basic pay within a calendar year and
should be paid not later than December 24 of each year.
2. Section 8 of P.D. 851 as amended. Every covered employer shall make a report on compliance to
the nearest Regional/Provincial Office on or before January 15 of each year.
3. Attach payrolls / vouchers duly signed by the employees as proof of compliance.

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