BTRCP
FORM
Please read instruction / requirements
below (click) before filling up applications....
Republic
of the Philippines
DEPARTMENT
OF TRADE AND INDUSTRY
Region VII
PROVINCE OF CEBU
Certificate
No. _________
Date Registered ________
Expiry Date ___________
O.R. No. _____________
Date Issued ___________
O R I G I N A L A P P
L I C A T I O N (APPLICATION FOR ORIGINAL
REGISTRATION OF A FIRM OR BUSINESS NAME OR STYLE
UNDER ACT NO. 3883 AS AMENDED BY ACT NO. 4147 AND REPUBLIC ACT 863)
(Please submit two(2) copies)
_________________________________________________________
FIRM NAME /BUSINESS
NAME/STYLE
(To be filled up by DTI Examiner)
1.
OWNER / REGISTRANT
A.
NAME B.
AGE C. TIN SURNAME
GIVEN
NAME
MIDDLE NAME
_______________ _________________
_________________ _____ _____
D.
RESIDENCE ADDRESS E.
RES. TEL. NO./S:
Number:
_______ Street: ________ Brgy.:
_______________________ _________________
City/Municipality/District:
______________ Province: _________________ _________________
F.
BUSINESS ADDRESS G.
BUS. TEL. NO./S:
Number:
_______ Street: ________ Brgy.:
_______________________ _________________
City/Municipality/District:
______________ Province: _________________ _________________
H.
CITIZENSHIP
1.
Filipino How acquired 1.a
Natural Born 1.b.
Election 1.c
Naturalization
2.
Foreigners
: State Citizenship _________________________
I.
MARITAL STATUS
1.
Single 2.
Married 3.
Widowed 4.
Other (Specify) ___________
J.
NAME OF SPOUSE (If Married) K.
NAME OF MANAGER Surname Given
Name M.I.
Surname Given
Name M.I.
___________ _____________ _____ ____________ _____________
_____
2.
FORM OF OWNERSHIP
1.
Single Prop. 2.
Partnership
3.
Corporation
4.
Others: __________
3.
CAPITALIZATION (To nearest thousand peso)
a.
If Corporation b.
If Single Prop./Part./Others
Authorized Subscribed
Paid-Up
P__________ P__________ P__________ P_________________
4.
NATURE OF BUSINESS
Code
No.: Total
No. of Employees: ________
a. Main Activity
Retailer
Wholesaler
Manufacturer
Dealer
Exporter
Importer
Processor
Producer
Printer
Lessor
Service
Trader
a.
Business Name: ___________________________ b.
Old Certificate No.___________________
c. Method of Acquisition:
1.
Sale 2.
Assignment 3.
Transfer
Has
the undersigned been convicted of any crime involving
moral turpitude or violation of law relating to trade,
commerce and industry?
YES
NO (If yes, state date, place
and nature of offense)
DATE
PLACE
NATURE
OF OFFENSE
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
(Attach certified
true copy of the decision of the court of competent jurisdiction
for any crime involving moral turpitude or violation of the law, ordinance
or regulation.)
I
hereby agree for a change and/or cancellation of the above mentioned
firm name, business name or style in the event that there is already
another person, firm or entity lawfully using the same, similar identical
name..
I hereby agree to continue the exhibition
of my name or business name or style on a signboard, exhibited in
plain view of the public in the premises of my business. I hereby
agree to notify DTI in case of transfer to a new location of theexact
address of the business establishment, not later than 10 days after
its transfer.
I hereby declare that the date furnished
by me in this application form are true and correct to the best of
my knowledge and belief and the same have been given voluntarily and
without any fraudulent or deceitful purpose whatsoever and that I
am aware that any false statement given by me will be a ground for
cancellation of my certificate. Further, I also hereby recognize and
accept the authority and power of the Department of Trade and Industry
or any of its duly designated representatives or agents to check and
monitor compliance of my business establishment with various trade
and industry laws and its implementing rules and regulations and violations
of the same shall be likewise a ground for the cancellation of this
certificate.