Republic of the Philippines

Department of Finance
BUREAU OF CUSTOMS
1099 Manila

INTELLIGENCE GROUP (IG)

CUSTOMS INTELLIGENCE AND INVESTIGATION SERVICES (CIIS)
ACCOUNT MANAGEMENT OFFICE (AMO)

APPLICATION FOR ACCREDITATION AND REGISTRATION

(Corporation / Partnership / Cooperative)

I, _______________, of legal age, with postal address at

________________________
_________________________________ after having been duly sworn in accordance
with law, hereby depose and say that;

1. I am the Operation Manager, duly authorized to file this

application for accreditation and registration with the Bureau of
Customs, as evidence by written authority from the company.

2. I hereby present the following information for accreditation with

the Bureau of Customs;

2.1 Name of the Firm: Silver Dragon Resources Inc.

a. Head Office Address:

Year/s of Stay in the Premises:

Nature of Occupation: ( ) owned ( ) leased ( )

shared
( ) others

b. Warehouse Address:

Year/s of Stay in the Premises: 4 years

Nature of Occupation: ( X ) owned ( ) leased (

) shared
( ) others ____________________________

c. Branch Office Address:

Year/s of Stay in the Premises:
Nature of Occupation: ( ) owned ( ) leased ( )
shared
( ) others

d. Contact Number/s:
e. Facsimile Number/s

f. Email Address: ___________________________

g. Number of Employees:

h. Nature of Company:

2.2 List of Officers / Directors (Please attach Personal Profile or

Resume)
Rosalina Galicia____
 Kristine G. Bensurto
Michael O. Lim
Rafael Bensurto
Julius Mangupag

1* Mandatory Field since Notice / approval will be sent via email

3. I hereby attached herewith the following documents:

( ) BCOR evidencing payment of application fee.

(X ) BIR Importer Clearance Certificate (BIR-ICC).
( /) Corporate Secretary Certificate for designated signatories, in
the import entries
with sample
Original signatures.
( ) Original copy of NBI Clearance issued within three (3) months
prior to the date
of application
Of responsible officers and majority stockholders.
( / ) Two (2) valid government issued I.D’s, with picture of applicant
( / ) Latest General Information Sheet, if a corporation
( / ) Personal Profile of applicant and responsible officers, duly
signed
( ) Company Profile with pictures of office and/or warehouse
premises
( ) Proof of lawful occupancy of office and warehouse premises:
______________
( ) Printed CPRS
( X ) Previous Certificate of Accreditation / Registration, if
applicable
( / ) License / Permit / Accreditation from concerned agency, where
applicable, i.e.,
food (LTO & CPR), rice (NFA), sugar (SRA), etc.
( X ) Endorsement from the Collector concerned, applicable

4. List of Importable Items with clear description in technical and

tariff, terms, estimated volumes and
Values for the next twelve (12) months
(Use separate sheet if necessary)

Commodity Tarif Technical Volume Value

(General Terms) Heading Description
REPUBLIC OF THE PHILIPPINES )
________________________ ) S.S.

SWORN UNDETAKING

I hereby certify under oath that all the above information are true and
correct; all documents submitted in support of this application are true
copies if the original, subject to verification; any mispresentation and/or
manifestation of the fraud in this application shall be a ground for the
disapproval of my application, and blacklisting of our firm and the
undersigned as the applicant.

As specified in Section 2.2 of CMO No. 4-2014, I hereby undertake to (a)

to receive notice by email; (b) to strictly abide with existing rules and
regulations on the Statement by Full Description of Imported Articles; (c) to
notify the BOC-AMO of any changes in designated signatory and email
addresses; and (d) to obtain knowledge of the contents of a declaration, and
to attest to the veracity thereof;

I fully understand that failure to comply with the undertaking will result
in the cancellation and revocation of the accreditation as importer, without
prejudice to the imposition of any other criminal sanction for violation of the
Tariff and Customs Code of the Philippines, and other customs laws and
regulations.

AFFIX 2X2 of the Very truly yours,

Proprietor / applicant
Latest photo, should no
Be more than 3 month old Applicant’s Name

By:
 ____________________
T.I.N.
_______________

SUBSCRIBED AND SWORN to before me this ______________ day of

_____ in Manila Philippines, affiant exhibiting to me his/her
__________________ issued at ______________ on _______________.

NOTARY PUBLIC

Doc No. ________

Page No. ________
Book No. ________
Series of ________

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