BPLS Unified Form

Annex 1 (Page 1 of 2) -Application Form for Business Permit

TAX YEAR__________
CITY/MUNICIPALITY_______________
ASSESSMENTS:
New Amendment: Mode of Payment
Renewal From Single to Partnership Annually
Additional From Single to Corporation Bi-Annually
From partnership to Single Quarterly
Transfer: From Partnership to Corporation
Ownership From Corporation to Single
Location From Corporation to Partnership
Date of Application: DTI/SEC/CDA Registration No.:
Reference No.: DTI/SEC/CDA Date of Registration:
Type of Organization: CTC No. TIN
Single
Partnership
Corporation
Cooperative
Are you enjoying tax incentive from any Government Entity? () Yes ( ) No Please specify the enti

Name of Tqaxpayer
First Name Middle Name
Buisiness Name
Trade Name/Franchise:
Name of President/Tre4asurer of corporation
Last Name First Name Middle Name
Business Address Owner's Address
House No./Bldg. No. House No./Bldg. No.
Building Name Building Name
Unit No. Unit No.
Street Street
Barangay Barangay
Subdivision Subdivision
City/Municipality City/Municipality
Province Province
Tel No. Tel No.
Email Address Email Address
Property Index No. (PIN):
Business Area (in sq.m): Total No. of Employees in Esablishment:
# of Employees Residing in LGU:
If place of Business is rented, please i Lessor's Name
Monthly Rental:
Last Name First name Middle Name
Lessor's Address
House No./Bldg. No. Subdivision
Street City/Municipality
Barangay Province
Tel.NO. Email Address:
In Case of emergency: Contact person/Tel No./
Mobile phone no./email address:
Business Activity CapitalizatiGross Sales/Receipts(For renewal)
No. of Units
Code Line of Business New BusineEssential Non-essential

Oath of Undertakings
I undertake to comply with the regulatory requirement and other deficiencies within 30 days from

SIGNATURE OF APPLICANT POSITION/TITLE

cify the entity.

0 days from release of the business permit

 Annex (Page 2 of 2) Application Form For Business
Application No. 000-000-000-0000
ASSESSMENT
LOCAL TAXES REFERENCE
AMOUNT PENALTY/SURCHARGE
DUE TOTAL
ASSESSED BY
Gross Sales Tax
Tax on delivery vans/trucks
Tax on storage for combustible/
flamable or explosive substance
Tax on Sign board/billboards
REGULATORY FEES AND CHARGES
Mayor's Permit
Garbage charges
Delivery trucks/vans permit fee
Sanitary Inspection Fee
Building Inspection Fee
Fire Inspection Fee
Medical Fee
Plumbing Inspection Fee/TAWAS
Signboard/Billboard Renewal Fee
Signboard/Billboard Permit Fee
Storage and Sale of Combustible/
flamable or explosive substance
Electrical Inspection Fee
Mechanical Inspection Fee
Mayor's Clearance
Police Cearance
Weight & Measurer Registration
Occupational Tax
VERIFICATION OF DOCUMENTS
Description Office/AgencyDate Issued VERIFIED BY: (BPLO Staff)
Barangay Clearance Barangay
Zoning Cearance Zoning Admin.
Sanitary/Health Clearance Mun. Health
Occupancy Permit Bldg. Official
Fire Safety Inspection Certificate City Fire Dept.
Please specify

ASSESSMENT REVIEWED BY: APPROVAL RECOMMENDED BY:

Instructions:
1. Provide accurate information and print legibly to avoid delays, incomplete application
form wil returned to the applicant.
2. Ensure that all documents attached to this application form are complete and properly filled out.
 COMPOSITION OF JOINT INSPECTION TEAM
City/Municipal Planning and Deve RENE R. MANAIT
MPDC

City/Municipal Building Official VIGILUS D. CREDO

Municipal Engineer

City/ Municipal Health Office DR. CARMEL MATHILDA B. LADEZA

Rural Health Officer

Office of the Health and Sanitatio DIOSDADO SALADAGA

Sanitary Inspector

City/Municipal Assessor's office GODFREY B. GIMON

OIC-Municipal Assessor

Committee on Market
Market Chairman

B.I.R. ANALYN PATIO

Collection Officer

COMPOSITION OF JOINT INSPECTION TEAM

City/Municipal Planning and Deve RENE R. MANAIT

MPDC

City/Municipal Building Official VIGILUS D. CREDO

Municipal Engineer

City/ Municipal Health Office DR. CARMEL MATHILDA B. LADEZA

Rural Health Officer

Office of the Health and Sanitatio DIOSDADO SALADAGA

Sanitary Inspector

City/Municipal Assessor's office DELIA A. CLAMOHOY

Municipal Assessor

Committee on Market BENJAMIN PAHAYAHAY

Market Chairman

B.I.R. ANALYN PATIO

Collection Officer
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