Department Of Labor And Employment printable pdf download

Republic of the Philippines

RKS Form 5

DEPARTMENT OF LABOR AND EMPLOYMENT

Page 1 of _

2010

pages

_____________________________

(Field Office/Regional Office)

Instructions:

1. Accomplish this form in two copies when filing a notice of termination due to closure/retrenchment. The report is

considered as duly filed when the complete list of workers affected is made part of the submission.

2. This form should be submitted to the DOLE Field Office 30 calendar days prior to the effectivity of termination .

3. Page 1 should contain general information about the establishment and the number of workers affected.

4. Page 2 should enumerate the names of workers affected, their addresses and contact numbers, position title and

salary.

Total number of workers listed should equal the total number of workers affected as reported in this page.

ESTABLISHMENT TERMINATION REPORT

A. Establishment Data:

Name of Establishment _______________________________________________________________

Floor/Bldg./No./Street/Subdivision ______________________________________________________

_________________________________________________________________________________

Barangay/City/Municipality ____________________________________________________________

Zip Code/Province ________________________________

GEOCODE: l l l l l l l l l l

Main Economic Activity (Specify product/goods/services):_________________________________

___________________________________________________________

PSIC: l l l l l l l

Total Employment:

No. of Female Workers:

Date of Filing of RKS Form 5 (mm/dd/yyyy): l l l l l l l l l

B. Permanently Terminated Workers Due to Closure/Retrenchment

Main Reason for

Effectivity Date

No. of Workers

Closure/Retrenchment of Workers

Affected

)

(mm/dd/yy

(Use code below, select only one)

Codes for Main Reason for Shutdown/Retrenchment of Workers:

LM – Lack of Market/Slump in Demand

RDS – Reorganization/Downsizing

UCP – Uncompetitive Price of Products

R - Redundancy

CI – Competition from Imports

CMM – Change in Management/Merger

HCP – High Cost of Production

LRM – Lack of Raw Materials

LC – Lack of Capital

MR – Increase in Minimum Wage Rate

PD – Peso Depreciation

OTH – Others (specify) __________________________

FL – Financial Losses

CERTIFICATION

This is to certify as to the accuracy of the data provided in this report.

Name/Signature of Owner/Company Representative:

Position:

Fax No.:

Tel. No.:

E-mail Address:

Department Of Labor And Employment

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