Republic of the Philippines
DEPARTMENT OF TRADE AND INDUSTRY
Cebu Provincial Office 3/F LDM Building, Legaspi Street, Cebu City
Phone: (6332) 2557084, 2557086 Fax: (6332) 2557609

RENEWAL APPLICATION FOR LICENSE AS AN IMPORTER, MANUFACTURER,
WHOLESALER, RETAILER OR SERVICE FIRM OF FIRE EXTINGUISHER,
SUPPLIES AND EQUIPMENT UNDER P.D. 1185 AND L.O.I. 727.
(Please submit one copy)


________________________________________________________
(Importer, Manufacturer, Wholesaler, Retailer, Service Firm of Fire
Extinguisher, Supplies & Equipment)

              The following are the pertinent information regarding my capacity to engage in said business:

Name of Applicant :
Age : Civil Status : Citizenship :
Residence : Telephone No. :
Location of Business : Telephone No :
Business Name :
Brand or Trade Mark of Fire Extinguisher, Supplies, or Equipment handled : 

 

                  I, __________________________, hereby declare under oath that the foregoing information are true and correct to the best of my knowledge, information and belief and the same have been given and voluntarity without any fraudulent or deceitful purpose whatsoever.

 

______________________________
APPLICANT              

TAN _________________________ 

             SUBSCRIBED AND SWORN BEFORE ME this day of , 20 , Affiant exhibiting to me his/her Residence Certificate No. __________ issued on_____________ 20 at Cebu City, Philippines.

 

_____________________________
NOTARY PUBLIC             
Until ______________20    

Doc. No. _________
Page No. _________
Book No. ________
Series of _________