02 For HWMS Affidavit - Attesting Truth Template

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

AFFIDAVIT

(to be duly notarized)

REPUBLIC OF THE PHILIPPINES ) s.s.


)

I, Sheila Amor S. Madrono_ of legal age, married, residing at


Barangay 10, Cagayan de Oro City after being sworn in accordance with law,
depose and say that:

1. I am an applicant for Hazardous Waste Generator Registration


pursuant to DAO 2013-22;

2. I am aware and understand all the duties, responsibilities and accountability


to be imposed upon me and DPCY Health Care Diagnostic and Drug Testing
Center by such application and as such will be liable for all the damages
incurred and for any untoward incident during its actual operation;

3. I attest to the truth, accuracy and genuineness of all the


information, documents and records contained and attached to this
application and that I and DPCY Health Care Diagnostic and Drug Testing
Center (COMPANY) shall be liable for any misrepresentation, fraudulent
declaration and all its consequences;

4. I am executing this affidavit as a proof of good faith in complying with


the requirements for securing the above mentioned registration certificate

IN WITNESS WHEREOF, I have hereunto set my hand this day


of 20 in .

Sheila Amor S. Madrono


Signature over printed name of affiant

You might also like