Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. X
Monte Carlo Bldg., RER Subdivision, Phase 1,
National Highway, Kauswagan, Cagayan de Oro City

CERTIFICATION
THIS IS TO CERTIFY THAT DOLE-X HAS CONDUCTED A RANDOM VERIFICATION OF
THE SUBMITTED BWC LIST OF VOLUNTARY REGULARIZATION INITIATED
by_______________________________ located at ________________________________
LIKEWISE, WORKERS AFFIXED THEIR SIGNATURE TO CONFIRM OF THEIR REGULAR STATUS
OF THE COMPANY.

Cagayan de Oro City, _______th day of _____________2018

Name of Worker Signature

______________________________ _______________________

______________________________ ________________________

______________________________ _________________________

______________________________ _________________________

_______________________________ __________________________

FOR MANAGEMENT: VERIFIED BY:

_______________________________ _________________________
Manager/Owner/Authorized Signatory Inspector/DOLE Representative

note: proof of regularization

(ex: appt. letters/Memo..etc)