Registration

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FORM NO.

1
Revised June 2015
Office of the President of the Philippines
MOVIE AND TELEVISION REVIEW AND CLASSIFICATION BOARD
MTRCB Building, No. 18 Timog Avenue, Quezon City, Metro Manila
Telefax Nos. 376-7358; 376-7380

APPLICATION FOR REGISTRATION

Instruction: Write “N/A” for entries not applicable to your application.

Date of Application: ______________________

Name of Applicant: ________________________________________________________________________________________________________


Doing Business under the name and style of:____________________________________________________________________________________
Address of Applicant: ______________________________________________________________________________________________________
Address of Entity Registered: ________________________________________________________________________________________________
Name of Proprietor/General Manager/President: _________________________________________________________________________________
Tel. No/s.: ___________________ Fax: ___________________ Cell Phone No.: ____________________ Email Address: ______________________

FOR THEATER OPERATORS:


Complete Address: ________________________________________________________________________________________________________
Is Theater Owner/Operator same as last year? ________________. If No, state name of new owner/operator: ________________________________
Is Theater air-conditioned?
FOR CATV: NTC P.A. or C.A. No. _______________________ Date of issuance: __________________ Service Area: ________________________

I hereby certify that all the above information are true and correct of my personal knowledge or based on authentic records.

__________________________________________________________
Printed name and signature of applicant or its authorized representative
____________________________________________________________
Registration Remarks: (to be filled out by MTRCB Registration Officer only)
_______________________________________
Official Capacity/Designation

Company TIN: ____________________________

SUBSCRIBED AND SWORN to before me this ____ day of _____________________, affiant personally exhibiting to me his/her
Government-issued ID No. ________________________ valid until ________________, as competent evidence of identity.

Doc. No. ______


Page No. ______ NOTARY PUBLIC
Book No. ______
Series of ______

DOCUMENTS TO BE SUBMITTED:

For New Registrants: For Renewals: (Should be done on or before last day of January.)
DTI/SEC Registration Mayor’s Permit / Under Oath (Channel Guide- Cable)
Articles of Incorporation/Partnership & By-Laws Special Power of Attorney (for sole proprietorship) or
BIR registration Secretary’s Certificate (for corporation) for your representative/s
Mayor’s Permit
NTC Provisional/Certificate of Authority and Copy of its Petition for such authority (for TV/CATV operators only).
Special Power of Attorney/Secretary’s Certificate for your representative/s

REGISTRATION FEE: EFFECTIVITY:


JULY 1, 2014 JULY 1, 2015
a) CATV (for every Provisional Authority) P5,300.00+1%LRF P6,084.00+1%LRF
b) THEATER (aircon); P4,629.00+1%LRF P5,323.00+1%LRF
(non-aircon) P2,300.00+1%LRF P2,650.00+1%LRF
c) TV STATION (Metro Manila); P9,250.00+1%LRF P10,650.00+1%LRF
(Outside Metro Manila) P5,300.00+1%LRF P6,100.00+1%LRF
d) OTHERS P4,700.00+1%LRF P5,300.00+1%LRF

NOTE: Registration renewal must be made on or before January 30.


A surcharge of 100% is imposed on late registrants.
After payment, please leave this application form at Window 2 of the Registration Unit.

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