Sworn Affidavit of Disclosure
Sworn Affidavit of Disclosure
CITY OF V A L E N Z U E L A ) s.s
x------------------------x
AFFIDAVIT OF DISCLOSURE
That I am an applicant for a certificate of registration with the Department ofLabor and
Employment to operate as job/service contractor/subcontractor under the business name
__________________________________________,with business address at
___________________________________________and duly registered with the Securities and
Exchange Commission.2.
Sworn disclosure that the registrant, its Officers and Owners or principal stockholders have
not been operating or previously operating as a contractor under different business name or entity;
the list of clients, if any, the number of personnel assigned to each client, if any, and the services
provided to theclient.5.
That I am executing this affidavit to attest to the truth of the foregoing facts.
Notary Public
Page No.__________
Doc. No.__________
Book No.__________
Series of ___________