ERD2F003 NAME OF ENTERPRISE ANNEX A ZONE LOCATION

ERD2F003 NAME OF ENTERPRISE ANNEX A ZONE LOCATION




ANNEX A

ERD.2.F.003


Name of Enterprise: ___________________________ ANNEX A

Zone Location: ___________________________________________


List of New/Additional Machines and Equipment for _________ Project

Under Registration/Supplemental Agreement with PEZA dated ____________





Description of Machines/ Equipment

 

 





Qty.

Particulars on Importation / Local Purchases

PEZA Permit Issued*

Name of Supplier / Source of Equipment

Address of Supplier / Source of Equipment

Invoice of Supplier / Source*

Type of Permit Issued (8101, 8105, 8112, others)

PEZA Permit Date

PEZA Permit No.


Date


No.


Cost**

 










 










*Please attach copy of PEZA permits issued and invoices of suppliers/sources

**Please indicate value in US$ or foreign currency per invoice and the equivalent in PhP


No. of workers: Direct (production): _______ Line Supervisors: _______Indirect/Admin.: _______ Management _______

No. of seats: _____________ (for I.T. enterprise only)


We certify: (a) that the above-listed machines/ equipment are the complete equipment being used for ___(name of company)_____’s _____(specify project)_____________ ; (b) to the completeness and accuracy of the above information; (c) that _____(name of company)______ acquired above listed machinery/equipment specifically for the above-subject project; and, (d) that _________(name of company)______ is the original owner in the Philippines of the above-listed machinery-equipment and that the same had not been previously used by ____(name of company other than for the above-subject project nor by any other manufacturing enterprise in the Philippines. Further, said machines/equipment have been: (Please check appropriate box)

[ ] Consigned by _(name& address of consignor)__ [ ] Purchased [ ] Leased from _(name & address of lessor)__


________________________ ____________________

Signature/Date Signature/Date


________________________________ ________________________________

Name/Designation of Enterprise Official Name/Designation of Enterprise Official

Validated and Attested by:


________________________________ ____________

PEZA-Zone Administrator/Manager/OIC Date

Validation of machines/equipment for confirmation of ITH entitlement and application for ITH extension under CELR criterion





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