EDD.1.F.

013
Revision 2, 01 December 2016

Republic of the Philippines

PHILIPPINE ECONOMIC ZONE AUTHORITY
Building 5, DOE-PNOC Complex, Energy Drive, 34th Street, Boniface Global City, Tausig City
Trunk Line No. 551-3451 Loc. 213 & 214 / Telefax No. 551-3440/E-mail Add: edd@peza.gov.ph

SCRAP BUYER'S REGISTRATION FORM

1. APPLICANT

Company/Enterprise Name :
TIN No. :
Business Address :
Owner/President/CEO : Signature :
Telephone No. : Mobile No. :
Fax No. : E-mail Add :

2. ORIGINAL COPIES OF THE FOLLOWING CERTIFICATES, PERMITS AND OTHER DOCUMENTS PERTINENT TO SCRAP-BUYING OPERATIONS
WITH ONE (1) CERTIFIED TRUE COPY

Certificate No. Date Issued

Current Mayor's Permit (with corresponding Official Receipt)
DENR Certificate of Non-Coverage (CNC) for buyers of scrap
materials not containing toxic / hazardous matters; or
DENR Environmental Compliance Certificate (ECC) for buyers of
scrap materials containing toxic and hazardous waste
DENR Certificate of No Violation
(relative to the ECC if issued more than one year)
Permit to Transport for scrap buyers withdrawing and transporting
scrap materials containing toxic and hazardous waste
Business Registration
(i.e. SEC Registration or DTI Business Name Certificate of Registration)

Previous Certificate of Scrap Buyer's Registration, if any

(original copy)
Anti-Graft Certificate (Notarized)

3. TYPES OF SCRAP MATERIALS COVERED BY SCRAP-BUYER'S OPERATIONS

Types of Materials: Enumerate clearly the nature of the scrap materials and their intended uses.
Ceramic Example 1: Plastic drums for re-use.
Paper Example 2: Rejected printed circuit boards for recovery of usable parts and components.
Glass Example 3: Cotton, acrylic and wool yarns for stuffing toys and pillows and other uses.
Plastic
Wood
Textile
Rubber
Leather
Chemical
Metal
Aluminum
Copper
Iron/Steel
Lead
Tin
Zinc
Others

4. ACKNOWLEDGMENT

Application/Order of Payment Issuance

Date Received : Registration Certificate No. :
Amount Paid : Date Issued :
O. R. No. : Received by :
Received by :
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Revision 2, 01 December 2016

ANTI-GRAFT CERTIFICATE

I, ___________________________________________, of legal age, President/General

Manager/Sole Proprietor 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 or 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 PEZA
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 or
Management.

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
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Revision 2, 01 December 2016