EDD.1.F.

001
Revised.8.12.09

APPLICATION FOR REGISTRATION OF

MANUFACTURING ECONOMIC ZONE

Date
Hon. LILIA B. DE LIMA
Director General
Philippine Economic Zone Authority

Madam:

Pursuant to sections 5 and 6 of Republic Act 7916, otherwise known as the Special Economic
Zone Act of 1995, as amended by RA No. 8748, I am applying for the development of an
area of ______________________________________________ square meters located at
________________________________________________________ into a Special Economic
Zone to be known as _________________________________________.

The undersigned attest that the documents/information submitted are true and are correct and that I
assume full responsibility for any misrepresentation and/or violation thereof.

Attached hereto are:

1. Duly accomplished and notarized PEZA Application Form and anti-graft certificate (R.A. 3019);
2. Board Resolution authorizing the filing of the application with PEZA and designation of representative(s)
authorized to transact registration with PEZA;
3. Securities and Exchange Commission (SEC) Registration including Articles of Incorporation and By-Laws;
4. Audited financial statements for the last three (3) years, if applicable;
5. Project Description (Development Plan and Timetable);
6. Site Development Plan;
7. Vicinity map indicating various land uses and important landmarks within a kilometer-radius of the proposed
economic zone;
8. Proof of land ownership or any document confirming the applicants authority to use the land subject of the
proposed economic zone;
9. Endorsement of the Sangguniang Bayan/Panlungsod of the proposed economic zone;
10. DAR Conversion clearance/exemption certificate or HLURB Zoning Certification, whichever is applicable.
11. Certification from the Department of Agriculture (DA) that the proposed area is not covered by Administrative
Order No. 20 and that such land has ceased to be economically feasible for agricultural purposes
12. Verified Survey Returns and technical description of the proposed economic zone area;
13. Environmental Compliance Certificate issued by the Environmental Management Bureau of the Department of
Environment and Natural Resources (EMB-DENR); and
14. National Water Resources Board (NWRB) Certification that the identified source of water shall not cause
supply problem for the adjacent communities.

Very truly yours,

President/CEO
 EDD.1.F.001
Revised.8.12.09

Republic of the Philippines

PHILIPPINE ECONOMIC ZONE AUTHORITY
Roxas Blvd. cor. San Luis Street, Pasay City, Metro Manila, Philippines
Telephone No. (632) 551-3440 Telefax No. (632) 551-9518 E-mail Add. edd@peza.gov.ph

APPLICATION FOR REGISTRATION OF

MANUFACTURING ECONOMIC ZONE

Date Filed
O.R. No. / Date

A. NAME OF THE ECONOMIC ZONE

B. APPLICANT
Company Name
TIN No.
Address
Telephone No.
Fax No.
Email Address
Website

C. AUTHORIZED REPRESENTATIVE
Name
Address
Telephone No.
Fax No.
Email Address

D. PROJECT BRIEF
The Proponent

1. Name of Company
2. Company Address
3. SEC Registration
 EDD.1.F.001
Revised.8.12.09

Cert. of Registration No.

Date
Amendment (if any)
Nature
Date

4. Nature of Business

5. Incorporators

NAME NATIONALITY

Use separate sheet/s if necessary

6. Current Stockholders
AMOUNT OF
NO. OF AMOUNT OF PAID-
NAME NATIONALITY SUBSCRIBES
SHARES UP SHARES
SHARES

Use separate sheet/s if necessary

7. Principal Officers

NAME POSITION
 EDD.1.F.001
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Use separate sheet/s if necessary

 EDD.1.F.001
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8. Capital Structure a. Authorized

b. Subscribed
c. Paid-Up

9. Affiliate Company

NAME OF COMPANY CAPITALIZATION

PhP

Use separate sheet/s if necessary

10. Other Project Involvements

YEAR
NAME OF PROJECT DESCRIPTION
ESTABLISHED

Use separate sheet/s if necessary

The Land

1. Location
2. Land Area
3. Existing Land Uses
a. Agricultural (indicate crops planted)

b. Non-Agricultural Barren/Idle Land Grassland

q Others

4. Zoning Classification on or before 15 June 1988

Residential Commercial
EDD.1.F.001
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Industrial Others
 EDD.1.F.001
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5. Topography Flat Slightly sloping

Hilly Very steep

6. Boundaries North

East

West

South

(Natural boundaries or land uses abutting the area)

7. Ownership/Right Over Land q Full Ownership q Lease Contract

q MOA q Joint Venture Agreement
q Others

8. Tenancy Status q Tenanted q Non-tenanted

9. Proximity to major ports

NAME OF SEAPORT/AIRPORT DISTANCE

10. Off-Site Infrastructure, Facilities & Utilities (brief description)

a. Accessibility and Mode of Transportation:

b. Telecommunication System
i.) Telephone provider
ii.) Other communication services

c. Power System
i.) Power source
EDD.1.F.001
Revised.8.12.09

ii.) Power franchisee

iii.) Power transmission and distribution
 EDD.1.F.001
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d. Water System
i) Source
ii) Distribution system

The Project

1. Proposed/Existing Facilities

COMPONENT AREA PERCENT

Industrial Area
Common Utility Area
Buffer Zone/Open Space
Others

TOTAL
Use separate sheet/s if necessary

2. Status of Development New development Under development

Existing/Fully developed

If new development
i) date of commencement
ii) expected date of completion

If under development
i) percentage completion
ii) date started
iii) expected date of completion

If existing/fully developed
i) date established
ii) status of occupancy
iii) line of business of occupants
 EDD.1.F.001
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3. Labor Requirements

Projected No. of Workers/Employees

Year
Direct Indirect
1
2
3
4
5
Average

4. Proposed/Existing On-Site Utilities, Facilities and Amenities

a. Internal Road Network

ROW Width (m) TYPE OF PAVEMENT

Main
i) Road
ii) Secondary Road
iii) Tertiary Road

b. Power System
i) Power source
ii) Power franchisee
iii) Power transmission and distribution
iv) Back-up power generation
Source
Capacity

c. Telecommunication System
i) Telephone provider
ii) No. of lines
iii) Telecommunication backbone
High speed voice and data communication

Others (i.e. WAN, bandwidth, broadband, satellite services, ISP, etc.)

EDD.1.F.001
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d. Water Supply System

i) Source
ii) Distribution system

e. Sewerage and Drainage System

f. Sewage Collection, Treatment and Disposal

i) Wastewater collection

ii) Wastewater treatment

iii) Wastewater disposal

iv) Wastewater recycling

g. Solid Waste Disposal System

h. Fire Fighting System

i. Other Utilities, Facilities and Amenities

5. Proposed Community Development Project

6. Proposed Improvements (for existing project, if any)

7. Support Institutions within 1 kilometer radius

EDD.1.F.001
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 EDD.1.F.001
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8. Estimated Project Cost Breakdown

COMPONENT AMOUNT
Land Acquisition Cost PhP
Land Development Cost
Horizontal development cost
Vertical development cost
Improvement Cost
Other costs

TOTAL PhP

9. Sources of Funds
SOURCE PERCENT SHARE

Use separate sheet/s if necessary

10. Preferred Locator

11. Prospective Locators (if any)

12. Marketing Program/Promotional Strategies

13. Environmental Management Program

a. Liquid Waste Management Program

b Solid Waste Management Plan

c Toxic and Hazardous Waste Management Plan

 EDD.1.F.001
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d Prevention and Abatement of Pollution (air, noise, water)

Done in the City/Province of ____________________________________________________________

this day of 20

___________________________
Affiant
____________________________
Designation

Republic of the Philippines )

) S.S.
Municipality/City/Province of

Subscribed and sworn to before me this day of 20

in the Municipality/City/Province of

Affiant exhibit to me his Residence Tax Certificate No

issued at on 20

_________________________________
Notary Public
Until December 31, 20______

Doc. No.
Page No.
Book No.
Series of
 EDD.1.F.001
Revised.8.12.09

APPLICANT'S UNDERTAKINGS

In applying for PEZA registration, the Applicant herewith makes the following representations and commitments:

1 . That the applicant is capable of operating, on a sound and efficient basis, and of contributing to the
objectives of the Philippine Economic Zone Authority in particular and to the development of the national
economy in general;
2 . That the project is economically, technically and financially sound;
3 . That the applicant proposes to engage, in good faith, in the creation of a market for its project/product;
4 . That the applicant has installed/undertakes to install an accounting system adequate to identify the
investments, revenues, costs and profits or losses of the project covered by this application separately from
the aggregate investments, revenues, costs and profits or losses of the other business activities of the
applicant not registered under Republic Act No. 7916, as amended by Republic Act 8748 or has
established/undertakes to establish a separate entity for the project/activities covered by this application if so
required by the Authority. (Applicable only if applicant is engaged or proposes to engage in undertaking or
activities in addition to the project covered by this application);

5 . That the applicant shall submit periodic reports and other information, pertaining to its activities in the
Ecozone that the Authority may require;
6 . That the applicant has read Republic Act No. 7916, as amended, and the Rules and Regulations adopted by
the PEZA and commits itself to abide by the provisions thereof as well as amendments thereto;
7 . The applicant will start and operate the project covered by this application within such reasonable time as
may be fixed by the Authority;
8 . That the applicant's Board of Directors has authorized the filing of this application in accordance with the
terms thereof if the applicant is a corporation;
9 . That pursuant to Section 2(p), Rule I of the PEZA Rules, the applicant's income derived within the ecozone
shall be subject to taxes under the National Internal revenue Code pursuant to Section 25 of the Act;

10 . That no Board member or officer of the Philippine Economic Zone Authority has an investment or any other
financial interest, direct or indirect, in the applicant's enterprise; and
11 . That there exists no dummy relationship between any of the stockholders and/or principal officers of the
applicant and any foreign individuals/business entity.

Done in the City/Province of

this day of , 20 .

Affiant

Designation
Republic of the Philippines )
S.S.
City / Province of )

Subscribed and sworn to before me this_________ day of ________________ , 20___ in the City/
Province of ______________________. Affiant exhibited to me his Resident Tax Certificate No. _____________
issued at ___________________________ on _______________, 20___

Notary Public
Until December 31, 20_____
Doc. No.
Page No.
Book No.
 EDD.1.F.001
Revised.8.12.09

Series of 20
EDD.1.F.001
Revised.8.12.09

ANTI-GRAFT CERTIFICATE

I, ___________________________________________, of legal age, President/General

Manager of __________________________________________________ with postal address at
_________________________________________________________ after having been duly
sworn, depose and say:

That pursuant to the provisions of Section 3 and 14 of Republic Act 3019 (Anti-Graft Act),
the applicant enterprise, _________________________________________________ has not
given or promised to give, and will not give, any gift to any officer employee of the PEZA in
connection with the filing and processing of this application, nor it will give such gift to any of said
officers or employees after approval of its application.

That based on the records of the applicant, no Board Member or Officer of the Philippine
Economic Zone Authority has an investment or other financial interest, direct or indirect, in the
applicant; and

That this certificate was made with the approval of applicant's Board of Directors.

Affiant

Subscribed and sworn to before me this__________ day of _____________, 20 _____ in

the City/Province of ________________. Affiant exhibited to me his Residence Tax Certificate No.
_____________________ issued at _______________________ on
_________________________.

Notary Public
Until December 31, 20_____

Doc. No.
Page No.
Book No.
Series of 20