Republic of the Philippines

Department of Information and Communications Technology

NATIONAL TELECOMMUNICATIONS COMMISSION
Regional Office No. II
Regional Government Center, Carig, Tuguegarao City Philippines
Telephone No. (078) 377-0724 • email address: ntcr2@yahoo.com
Fax/Telephone No. (078) 304-1538

CERTIFICATE OF NON OPERATIONAL DEVICES

I/WE/THE ________________________________________ with business address at

____________________________________ have knowledge that the following device(s) listed below
was/were not operative and therefore not being used in the conduct of business operations so as to cause
registration fees to become due and demandable before this office.

UNIT SERIAL NUMBER REMARKS/CONDITION

I certify/declare under risk of perjury that the above stated are true and correct to the best of my knowledge.

_______________ ____________________________ _____________________________

Date Signature Attesting Officer

Certified correct:

_____________________
ATTY. MYRA C. DE GUZMAN

”Improving the Life of Every Filipino through ICT Services and Consumer Protection”