For Branch or Representative Office or Regional Headquarters or Regional Operating Headquarters

TIEZA sworn certification for branch or representative office or regional headquarters or regional operating headquarters

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: APPENDIX 10.3B
(As amended by Circular No. 794 dated 18 April 2013)

(Suggested Format for Branch/Representative Office/Regional Headquarters/
Regional Operating Headquarters)

I, _____________________________________, of legal age, ____________________
(Name of Affiant)


and a resident of the Philippines, after being duly sworn to in accordance with the law,
hereby depose and state that:
1. I am the __________________________________________________
(Authorized Officer’s Position)

of_______________________________________________________, with
(Name of Investee firm)

address at ____________________, herein referred to as the investee firm;
2. That herein foreign investor, ________________________, is a foreign
entity incorporated under the laws of _________________________ and
duly licensed by the Securities and Exchange Commission under License No.
___________ issued on __________________ to establish its
branch/representative office/regional headquarters/regional operating
headquarters (B/RO/RHQ/ROHQ) in the Philippines the purpose of which is
to ___________________________________________________________
3. That said foreign investor has inwardly remitted, and converted into
Philippine pesos (PHP), if applicable, thru an authorized agent bank (AAB)
the amount of USD/other foreign currency __________________________
on __________________, per Certificate of Inward Remittance (CIR) of
Foreign Exchange No. _________________________________ issued by
_________________________ on____________________;
(Name of AAB)

4. That the equivalent amount of the foreign currency in PHP
________________ was recorded in the books of B/RO/RHQ/ROHQ as
assigned capital or operational working fund;
5. That the investment certified herein plus previous investment/s (less
repatriation, if any) totals PHP __________________; which is in line with
existing laws to establish B/RO/RHQ/ROHQ in the Philippines.
I have hereunto set my hand this ___________ day of ___________________ 20__ at
(Signature over Printed Name)
SUBSCRIBED AND SWORN TO before me this _____day of_____________20___, at
____________, Philippines affiant exhibiting his/her (government-issued identification card) no.
______________issued on ________________ at _________________, Philippines.
Witness my hand and notarial seal on the date and place above-written.
Doc. No. __;
Page No. __;
Book No. __;
Series of ___.

N.B. The above form may be amended as appropriate.