Your Organization Name [Click here and type return address]

Assertion Declaration of Internal Controls

2018年4月9日 星期一

Click here and type Audit Firm address

Whereas, the United States Securities and Exchange Commission (the “SEC”) adopted rules under the Securities Exchange Act of 1934 which implement Section 302 of the Sarbanes-Oxley Act of 2002 (the “Exchange Act Rules”);

Whereas, the Exchange Act Rules require the Chief Executive Officer and Chief Financial Officer (each a “Certifying Officer” and collectively, the “Certifying Officers”) of [your organization name] to certify in each of the company’s periodic reports filed with the SEC that he/she/they are responsible for establishing and maintaining disclosure controls and procedures and that, as of a date within 90 days prior to the filing of the applicable report, he/she/they has/have evaluated the effectiveness of the company’s internal disclosure controls and procedures;

Whereas, the company’s current internal disclosure controls and procedures have been memorialized in various documents included in the documentation catalogue of the SEC Compliance Project;

Now therefore, the company’s Chief Executive Officer and Chief Financial Officer hereby attest to the establishment and evaluation of the internal disclosure controls and procedures and do hereby assert to their effectiveness.

Certifying Signatures:

[CEO Name], Chief Executive Officer: ______[FCO Name], Chief Financial Officer: ______