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Application For Certificate of Registration/Permit To Operate

This document is an application for a certificate of registration or permit to operate a private port facility. It requests information about the applicant/company, authorized representative, address, contact details, tax identification number, business type, and nature of business. It also requests details about the private port facility such as its type, draft, dimensions, location, lease contract number, area size, and term of the permit. Finally, it includes a checklist of basic documentary requirements and spaces for PPA use to record the application status.

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alejandroignaya
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18 views1 page

Application For Certificate of Registration/Permit To Operate

This document is an application for a certificate of registration or permit to operate a private port facility. It requests information about the applicant/company, authorized representative, address, contact details, tax identification number, business type, and nature of business. It also requests details about the private port facility such as its type, draft, dimensions, location, lease contract number, area size, and term of the permit. Finally, it includes a checklist of basic documentary requirements and spaces for PPA use to record the application status.

Uploaded by

alejandroignaya
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
Download as pdf or txt
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Tracking No.

____________

APPLICATION FOR CERTIFICATE OF REGISTRATION/PERMIT TO OPERATE


APPLICANT PROFILE
Name of Applicant/Company:

Name of Authorized Representative:

Address 1 (Office Address) Telephone Number 1:

Address 2 (Billing Address): Telephone Number 1:

E-Mail Address: Fax Number

Tax Identification Number (TIN) SEC Registration Number BDT No.

Business Type:
Single Proprietorship Partnership Corporation
Nature of Business:

PRIVATE PORT PROFILE


Port Facility/Structure to be Put-Up: Wharf Pier Others

Draft: ____________________________ Date Constructed : _________________ No. & Type : ________________


Dimensions: Utilization:

Location/Site of Private Port:


Barangay _____________________ Municipality/City of _________________________
Foreshore Lease Contract No. TCT No. (Back-Up Area)

Area size (in sq.m.)


Duration/Term of Permit: No. Of Mos. ____ No. Of Yrs. ______

Outstanding Obligation with PPA, if any: Permit to Construct, O.R. No. (if applicable)
DOCUMENTARY CHECKLIST VALIDATION FOR PPA USE ONLY
(Put () if submitted, (x) is not available)

Basic Requirements: Filing Fee Certification Fee


O.R. No. O.R. No.
Unified Application Form Date of Payment __________ Date of Payment __________

Duly Notarized Omnibus Undertaking (Sworn Affidavit) Type of Application: New Renewal

Received by:

Printed Name and Signature

Remarks:

Status as of _______________________

Approved Denied Pending

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