Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
( )
Renewal
( ) Extension
( ) Change of Name
( ) Modification
1. General Information:
Name of Enterprise:
_________________________________________________________________
Address:
__________________________________________________________________________
Name of Establishment:
______________________________________________________________
Address:
__________________________________________________________________________
TIN: ____________ Nature of Business:
_________________________________________________
Nature of Ownership: ( ) Single Proprietorship ( ) Partnership
( ) Corporation
Authorized Capital: ________ Paid Up Capital: ____________ Date of Start of Operation
__________
Name f CEO: _____________________ Tel No. _________________ Fax No.
___________________
Total Employees: _____________ Office: _______________ Production:
_______________________
Office Operation: ____ hrs/day _____ days/wk
Production Operation _______ hrs/day
____day/wk
Land Area Occupied: _____sq.m Open Area: ______ sq.m. ( ) Owned ( ) Leased ( )
Shared
Classification: ( ) Industrial ( ) Commercial ( ) Residential ( ) Agricultural ( )
________________
2. Raw Materials & Product Information
Raw Materials
Quantity
( ) Not Applicable
Products
Quality
APSI
Control Facility
I hereby certify that the above information are true and correct to the best of my knowledge.
Done this __________ day of _________________ 20_______.
______________________________________
Name and Signature of Pollution Control Officer
__________________________
Chief Executive Officer
SUBSCRIBED and SWORN to before a Notary Public. This _____ day of _______ affiant exhibiting to me his/her
Community Tax Receipt No. ________________ issued at ______________ issued on ________________
NOTARY PUBLIC
INSTRUCTIONS
1. Fully accomplish this form and complete all the supporting documents indicated hereunder.
Submit all documents in triplicate copies to our Air Quality Management Section of the Pollution
Control Division for screening, assessment of fees, and issuance of Order of Payment.
2. Pay to the Cashier Section the corresponding amount indicated in the Order of Payment and
present the Official receipt to Air Quality Management Section for recording and notation of your
application.
3. Submit your application to the Records Unit and ask for your receiving copy.
Your application shall be acted upon within twenty five (25) working days and you shall be informed of
our action accordingly.
Types of Application
New
Additional/Modification
Change of Name/Ownership
Renewal
Documents Required
Item Nos. 1, 2, 3, 4, & 5
Item Nos. 1, 2, 3, 4, & 5
Item Nos. 4, 6, 7, & 5
Item Nos. 6 & 9
Supporting Documents
or