SuSD.1.F.

012
Rev. 01, 31 July 2019

CERTIFICATE OF COMPLETION
Scope of Work: Electrical

The PEZA Building Official:

This is to certify that the electrical works on the building/facility covered by Electrical Permit No. ___________________
issued on _____________ have been completed in accordance with the approved plans and specifications on file with the Office
of the Building Official and in conformity with the provisions of the "National Building Code of the Philippines" (P.D. 1096).

The said electrical works are ready for your final inspection which is prerequisite to the issuance of "Electrical Permit-
to-Operate".

Name of PEZA-registered Enterprise:

Project Title (consistent with the issued Electrical Permit):

(NOTE: In case of partial application, indicate exact location using gridlines and emphasize the specific area)

Address of PEZA Enterprise:

Location of the Project :
Use or Type of Occupancy:
Proposed Date of Start of Installation: Expected Date of Completion:
Actual Date of Start of Installation: ACTUAL DATE OF COMPLETION:
Estimated Cost (PhP) :
ACTUAL PROJECT COST (PhP) : (for statistical purposes only)
Note: List down the electrical equipment and/or Devices (Quantity and Description) - must be supported by an accomplished Electrical Data Sheets.

Full Time In-Charge of Installation: If Project is Undertaken by Contract:

Contracting Entity:
Name and signature of electrical practitioner: PEE REE RME

PRC Reg. No.: PCAB License No.

Vaid Until : PCAB Category :
PTR No.: PCAB Classification:
Date Issued: Tax Identification No.:
Place of Issue : Address:

Conforme:

Name and signature of PEZA Enterprise Owner Name and signature of Contracting Entity's AMO
(Applicant)

Designation Designation

Republic of the Philippines)

City/Munipality of ___________________ ) SS.

SUBSCRIBE AND SWORN before me this, , in the City/Municipality of

exhibiting to me their with I.D./License/Passport No. as proof of their identities.

Doc. No. ;
Page No. ;
Book No. ;
Series of . Notary Public
(Attach proof of identity of PEZA Enterprise Owner and Contractor)