Use of Representative: 1. Your Full Name
Use of Representative: 1. Your Full Name
Use of Representative: 1. Your Full Name
A representative is someone who has provided advice or guidance to you prior to submitting your
application, following the submission of your application, and/or someone who has your permission
to conduct business on your behalf. You may have one representative only. If you appoint an
additional representative, the previous representative will no longer be authorized to conduct
business on your behalf and receive information on your �ile.
Business Address
Position
I authorize the following individual to serve as my representative and to conduct business on my behalf with
Quezon City Business Permit and Licensing Department.
Mailing address
Postal code/ZIP
Telephone number
E-mail address
By indicating your representative’s email address, you are hereby authorizing BPLD to transmit your file and personal information
to this specific email address.
Date (YYYY-MM-DD)
8.
I declare that I have fully and truthfully answered all questions on this form and any attached document (if
applicable).
I also declare that I have read and understood all the statements on this form, having asked and obtained an
explanation for every point that was not clear to me.
ID Number
Signature of applicant
(YYYY-MM-DD)
Date