ASEAN CHARTERED PROFESSIONAL ENGINEER

Republic of the Philippines

STATEMENT OF COMPLIANCE WITH CODE OF ETHICS

I, ______________________________, of legal age, Filipino citizen, single/married, with postal

address at _________________________________________________, hereby depose and state in
accordance with law, that I will abide and comply with the principles enshrined in the Code of
Ethics of the _______________________ profession.

______________________________
Name and Signature of Applicant
__________________________
Date

Subscribed and sworn to before me this ______day of ___________ 20__ at ______________,

affiant exhibited to me his Community Tax Certificate No. ___________ issued at
_______________ on _______________________.

______________________________
(Person Administering Oath)
Doc. No. _________
Page No. _________
Book No. _________
Series of 2014