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Affidavit-for-Fee-Exmption-format

This document is an affidavit for registration fee exemption for Non-Immigrant Temporary Workers, certifying that the applicant is a management employee authorized to represent the company. The affidavit states that the company qualifies for the exemption based on contracts awarded before or after the enactment of P.L. 34-98, with conditions regarding project amendments and penalties for unauthorized worker usage. The document requires notarization to validate the declaration under penalty of perjury.

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10 views

Affidavit-for-Fee-Exmption-format

This document is an affidavit for registration fee exemption for Non-Immigrant Temporary Workers, certifying that the applicant is a management employee authorized to represent the company. The affidavit states that the company qualifies for the exemption based on contracts awarded before or after the enactment of P.L. 34-98, with conditions regarding project amendments and penalties for unauthorized worker usage. The document requires notarization to validate the declaration under penalty of perjury.

Uploaded by

vijo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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(Submit on Company Letterhead)

AFFIDAVIT FOR REGISTRATION FEE EXEMPTION

I, _____________________________________, _________________________________ hereby certify


(Name) (Title)
that I am a management employee of _____________________________ and that I am empowered to
bind my company to agreements and speak on behalf of my company. I am applying for an exemption to
the registration fee increase for Non-Immigrant Temporary Workers enacted by P.L. 34-98.

I attest that my company, ______________________________________, qualifies for the exemption of


the fee increase based on the following criteria:

 Contract(s) / project(s) identified in my Project Summary Sheet, submitted to the Alien Labor Processing &
Certification Division, were entered into/awarded prior to the enactment of P.L 34-98. My bid was submitted prior to
the law’s passage and is not subject to amendment or renegotiation.

 Contract(s) / project(s) identified in my Project Summary Sheet, submitted to the Alien Labor Processing &
Certification Division, were awarded after the enactment of P.L.34-98. My bid was submitted prior to the law’s
passage and is not subject to amendment or renegotiation.

I understand that this fee exemption is based on the conditions at the time of registration and that I may not
be allowed to amend my Project Summary Sheet to allow for any additional projects under 17 GAR §7120 in
the future. I further understand that any usage of my workers on unauthorized projects may subject my
company to fines of up to $500.00 per day / per worker.

Under penalty of perjury, I declare that the above statement is true and correct to the best of my knowledge and
belief.

____________________________________________
Name: Print & Sign

Guam )
) ss.
CITY OF HAGATNA )

BEFORE ME, A NOTARY PUBLIC, in and for the Territory of Guam, personally appeared
______________________________, a person known to me to be the person whose name is subscribe to the within
instrument and acknowledged to me that they executed the same of their own free act and will.

IN WITNESS WHEREOF, I have hereunto affixed my name and official seal in the City of Hagatna this ________day of
____________________ 20_____.

___________________________
NOTARY PUBLIC

ALPCD USE ONLY

 Exemption Approved
 Exemption Disapproved

_____________________________________________ ______________________
ALPCD Administrator Date

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