Documente Academic
Documente Profesional
Documente Cultură
JOINT AFFIDAVIT
after having been duly sworn in accordance with the law, do hereby depose and say:
* (use extra sheet, if necessary, * (if for end-use / lab. use purposes,
and mark as annex)* please provide details) *
That, the above cited controlled chemicals and/or its mixtures shall be solely used for the legitimate purpose governing
the nature of the applicant’s legitimate existence, and in no case will it be diverted to illegal purposes.
That our PDEA License [ ] will expire / [ ] expired on _______________________________________ and our
latest Semi-Annual Report (SAR) was submitted to PDEA Compliance Service on ____________________________________________.
* (This paragraph is applicable for renewal applicants only. Delete paragraph if new applicant) *
That, for and in behalf of our establishment and by virtue of this Affidavit, we hereby bind ourselves to all the
provisions of Republic Act 9165 otherwise known as the “Comprehensive Dangerous Drugs Act of 2002”, and its implementing Rules and
Regulations and assuring that such law and regulations shall be faithfully complied with;
That, we are executing this Affidavit to attest the truth of the foregoing facts, and for whatever legal intent and
purpose it may serve.
IN WITNESS HEREOF, we have hereunto set our hands this _____________day of __________________, 20______
at ______________________________________, Philippines.
Affiant Affiant
(Head/owner/GM/BM of company) (PDEA-Registered Signatory)
SUBSCRIBED AND SWORN to before me this ___________day of __________________________________, 20____at __________________________, Philippines.
Affiants personally exhibiting their [ ] Community Tax Certificate Nos. / [ ] valid Government-issued ID Nos. ___________________ and ___ issued
on______________and _____ at and , respectively.
NOTARY PUBLIC
Doc. No.
Page No.
Book No.
Series of
NOTE: WHEN ACCOMPLISHING THIS AFFIDAVIT, PLEASE DELETE TEXTS IN RED FONT (WITH *).
FOR LATE RENEWAL AND LATE SAR SUBMISSION PLEASE SUBMIT THREE (3) COPIES OF THIS AFFIDAVIT.