Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

(Regional Office/Distric Office/Provincial Ext. Unit)

ESTABLISHMENT TERMINATION REPORT

National Capital Region Month/Year____________________

Instructions: 1. Accomplish this form upon filing of notice of termination 2. Make sure that your answer are true and complete 3. Page 1 should contain general information about the establishment and the nature of workers retrenched or terminated 4. Page 2 should include the list and information on workers affected. NAME OF ESTABLISHMENT:___________________________________________________ ADDRESS:_____________________________________________________________________ PRINCIPAL PRODUCT/MAIN ACTIVITY:_________________________________________ TOTAL EMPLOYMENT:_________________________________________________________ Number of Workers Affected GEOCODE PSC CODE

Effectivity Duration Date (in weeks Use code Below)

1.Total workers affected due to shutdown/ Closure of establishment Permanent Closure/Shutdown Temporary Closure/Shutdown 2.Total workers affected due to retrenchment/termination/dismissal Permanent Layoffs Temporary Layoffs Rotation of Workers Reduced Worktime/workdays

______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________

____________ ____________ ____________ ____________ ____________ ____________ ____________ ____________

___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________

3. Reason for shutdown/closure/retrenchment of workers (Use Code Below

Main reason:____________________ Other reason:___________________

Duration

CODING SYSTEM Reason for Establishment Closure/Layoffs/Retrenchment Economic Reasons

MR-Increase in minimum wage rate CI-Competition from imported products UCP-Uncompetitive price of product R-Redundancy CMM-Change In Management/Merger RDS-Company reorganization/ Downsizing FL-Financial Losses LM-Lack of Market/slump in demand LRM-Lack of raw materials LC-Lack of Capital HCP-High cost of production PD-Peso Devaluation OTH-Others (Specify)___________

1-Less than one week 2-1 to 2 weeks 3-3 to 4 weeks 4-5 to 12 weeks 5-13 weeks to less than 6 months 6-6 months 7-Indefinite 8-Not stated

Non-Economic Reasons
NCL-Calamities (fire, typhoon, etc.) SM-Serious Misconduct NIV-Inventory AWOL-Absence without Leave NRM-Repair general Maintenance PC-Project completion RES-Resigned RET-Retirement GHN-Gross Habitual Neglect OTHS-Others (specify)__________