CHECKLIST OF REQUIREMENTS: PHILIPPINE CONTRACTORS ACCREDITATION BOARD

Complied
N/A

No PCAB Yes PCAB-PAD-ARC-F01 F 00 [ ] Checklist of Registration Application: [ ] APPLICATION FOR REGISTRATION ANDO Revision 09-28-2009 CLASSIFICATION OF CONTRACTOR FORR Eff. Date 1. General Information (Page 3 of 4). M 1 of 4 GOVERNMENT INFRASTRUCTURE PROJECTS Page

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2. List of Single Largest Contract completed by the contractor of each Project Kind being applied for (Page 4 of 4). 3. Copy of Contract Agreement listed in Page 4 of 4 of each Project Kind being applied for duly authenticated by the tendering agency or project owner Application of Registration and The following pertinent documents and information shall be submitted in support ofor in case for subcontract application.(Applicant may contractor. check boxes subject for final validation by PCAB/DTI-ROG pre-screener) by the prime/main Initially fill out the 4. Copy A. LEGAL of Certificate of Acceptance/Completion from Tendering Agency/Project Owner of each Contract Agreement submitted duly authenticated by the tendering agency or project owner or in case of subcontract by the prime/main contractor.
REQUIRED ITEMS

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Classification license

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In behalf of ________________________________________________________________________ (Name of Firm) B. OTHERS a contractor duly licensed with the Philippine Contractors Accreditation Board. I hereby request for registration pursuant to the implementing Rules and Regulations of forms including B.1. Original Signature of AMO on each and every page of the applicationPD 1594, as amended. [ ] [ ] [ ] supporting documents. I hereby certify that the information and documents contained in this application are true and correct of B.2 Self-stamped envelopes (One self am fully mailing envelope is required held personally liable] for[ any [ ] [ ] my own personal knowledge. I stamped aware that I shall be for each supporting documentmay be found a prepaid courier pouch.. submitted) or herein. misrepresentation that FOR PCAB/ DTI-ROG USE ONLY
No. of PrePrescreening Results screening 1st [ ] Comply lacking items as listed in the Remarks Accepted 2nd [ ] Comply lacking items as listed in the Remarks Accepted 3rd [ ] the Philippines ) Republic ofComply lacking items as listed in the Remarks Accepted Province of ______________)

5. Copy of Certificate of Creditable Income Tax Withheld (Form 1743.1/1743.750/2307), stamped-received and certified by BIR for each private contracts and sub-contracts.

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____________________________________ Filed Pre-screener / Date Authorized Managing Officer (Signature over Printed ] [ ] PCAB Makati [ ] DTI-ROGName)
[ ] PCAB Makati [ ] DTI-ROG [ ] PCAB Makati [ ] DTI-ROG

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City/Municipality of ___________) S.S

SUBSCRIBED AND SWORN TO before me this ________ day of ___________________ 20 _____ at __________________; affiant exhibited to me his Community Tax Certificate No. _____________ issued at __________________ on _________________ 20 ___.
REMARKS:
LETTER / ITEM NO. COMMENTS:

NOTARY PUBLIC (Until December 31, _______)

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

CONTRACTORS GENERAL INFORMATION Contractors Particulars

FIRM NAME: OFFICE ADDRESS:

F O R M

PCAB PCAB-PAD-ARC-F01 Revision 00 Eff. Date 09-28-2009 2 of 4 Page

TEL. NO.:

TYPE OF ORGANIZATION: EQUITY:

Corporation %

Partnership %

Sole Proprietorship

Filipino:

Foreign:

License Particular
Contractors License No.: Principal Classifications: Other Classification(s): Date Issued: Last Renewal:

CFY _____ - _____

Present Category:

_____________________________________________________________________ _____________________________________________________________________
Ref. No.:

Type of application for PCAB License amendment, if any:

Government Registration Particulars

PRESENT REGISTRATION VALIDITY PERIOD, if applicable: from _______________ to ________________ APPLICATION APPLIED FOR: New Registration Re-registration Upgrading Additional Project Kind SIZE RANGE Please indicate if: Small A, Small B, KIND OF PROJECT Medium A, Medium B, (Please check) Large A, Large B __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________
GENERAL ENGINEERING GE-1 Road, Highway pavement, Railways, Airport horizontal structures & Bridges GE-2 Irrigation and Flood Control GE-3 Dam, Reservoir, and Tunneling GE-4 Water Supply GE-5 Port, Harbor and Offshore Engineering GENERAL BUILDING GB-1 Building and Industrial Plant GB-2 Sewerage and Sewage Treatment/Disposal Plant GB-3 Water Treatment Plant and System GB-4 Park, Playground and Recreational Work SPECIALTY SP-1 SP-2 SP-3 SP-4 SP-5 SP-6 SP-7 SP-8 SP-9 SP-10 SP-11 SP-12 SP-13 SP-14

Foundation Work Structural Steel Work Concrete Pre-casting and Pre-stressing Plumbing and Sanitary Work Electrical Work Mechanical Work Air-conditioning and Refrigeration Work Elevator and Escalator Work Fire Protection Work Waterproofing Work Painting Work Well Drilling Work Navigation Facilities Communication Facilities CERTIFIED CORRECT BY:
_______________________________________ Authorized Managing Officer/Proprietor (Signature over Printed Name)

TRACK RECORD FORM

F O R M

PCAB PCAB-PAD-ARC-F01 Revision 00 Eff. Date 09-28-2009 3 of 4 Page

(Only complete form & supporting documents will be considered) ___________________________________________________________ (Name of Firm) ______________ (License No.)

SINGLE LARGEST CONTRACTS COMPLETED

For _________________________________________________
Project Kind applied for (e.g. Road, Building etc.) 1. CONTRACT
Project Title: _______________________________________________________________________ _________________________________________________________________________ ___________________________________________________________________ Project Location: _____________________________________________________________ Project Owner: _________________________________________________________ Date of Contract: ___________________ Amount of Contract: P _______________________ Name of Main Contractor or Joint Venture, if any: ____________________________________ Percent (%) share of the applicant in the contract: ____________ %

2. ACCEPTANCE
Date of Document: _________________________ Name of Signatory: _________________________ Date Accepted: __________________ Position: ________________________

3. WITHHOLDING TAX (for subcontract and non-government contract)

Withholding agent: _____________________________________________________________ Name of the withholding agent's signatory: ___________________________________________ Received and Stamped by: { BIR { BANK RDO No._________________________ Name: ___________________________ Address:_________________________ Address: ___________________________ _________________________ ___________________________ Date: _________________________ Date: ___________________________

INSTRUCTIONS:

1. Attach at the back of this form clear & legible copies of the following documents: a) Contract agreement duly authenticated by the tendering agency/project owner/ prime contractor in case of subcontract. b) Letter or certificate of acceptance duly authenticated by the tendering agency/ project owner/ prime contractor in case of subcontract. c) Certificate of creditable income tax withheld of source (BIR Form 1743.1, 1743.750 or 2307) duly stamped-received by the BIR or Bank Collecting Agent for subcontracts & non-government or private contracts) 2. Submit only one track record for each project kind.

_______________________________________________ Authorized Managing Officer/Proprietor (Signature over Printed Name)