Tarlac - San Antonio - Business Permit - New

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APPLICATION FORM FOR BUSINESS PERMIT

TAX YEAR 2018

INSTRUCTIONS:
1. Provide accurate information and print legibly to avoid delays. Incomplete application form will be returned
to the applicant.
2. Ensure that all documents attached to this form (if any) are complete and properly filled out.
I. APPLICANT SECTION Date of Application:
1. BASIC INFORMATION
New Renew Mode of Payment: Annually Semi-Annual Quarterly
TIN: DTI/SEC/CDA Registration No.:
Type of Business: Single Partnership Corporation Cooperative
Amendment: From Single Partnership Corporation
To Single Partnership Corporation
Are you enjoying tax incentive from any Government Entity? Yes. Name of Govt. entity. ________________________
No
Name of Taxpayer/Registrant
Last Name: First Name: Middle Name:
Business Name:
Trade Name/Franchise:

2. OTHER INFORMATION
Business Address:
Postal Code:
Telephone No.: Mobile No.: Email Address:
Owner's Address:
Postal Code:
Telephone No.: Mobile No.: Email Address:
In case of emergency, provide name of contact person:
Telephone/Mobile No.: Email Address:
Business Area (in sq. m.): Total No. of Employees in Establishment: No. of Employees Residing within
LGU:

Note: Fill out Only if Business Place is Rented. Attach copy of Lease Contract/Agreement
Lessor's Full Name:
Lessor's Full Address: Postal Code:
Lessor's Full Telephone/Mobile No.: Lessor's Email Address:
Monthly Rental: Size of Land/Building/Space Leased/Rented: SQM

3. BUSINESS ACTIVITY
Capitalization Gross/Sales Receipts (for Renewal)
Line of Business No. of Units (for New Business) Essential Non-Essential

I DECLARE UNDER PENALTY OF PERJURY that the foregoing information are true based on my personal knowledge and
authentic records. Further, I agree to comply with the regulatory requirement and other deficiencies within 30 days from
release of the business permit.

CHECKLIST OF REQUIREMENTS
SIGNATURE OVER PRINTED NAME OF APPLICANT/TAXPAYER
Community Tax Certificate (CTC)
Barangay Business Clearance
Certificate of Registration POSITION/TITLE
SPECIAL REQUIREMENTS
Zoning Clearance
Medical Clearance Verified by:
License of Embalmer (if needed)
Real Property Tax Clearance REYNALDO E. PIEDRA
BPLO Designate
ANNEX 1 (Page 2 of 2)

II. LGU SECTION (Do Not Fill Up This Section)


1. VERIFICATION OF DOCUMENTS
Description Office/Agency Yes No Not Needed
Occupancy Permit (for New) Office of the Building Official/Mun. Engineer
Barangay Business Clearance Barangay
Sanitary Permit/Health Clearance Municipal Health Office
Provincial Environment Certificate Provincial Envi. and Natural Resources Office
RPT Tax Clearance Mun. Assessor's Office
Market Clearance (for Stall Holders) Office of the Market Administrator
Valid Fire Safety Inspection Certificate Bureau of Fire Protection

Verified by:

BPLO

III. MUNICIPALITY FIRE STATION SECTION DATE:


(TO BE FILLED UP BY APPLICANT/OWNER) APPLICATION No.:

Name of Applicant/Owner: ______________________________________________________________________


Name of Business: ______________________________________________________________________________
Total Floor Area: ______________________________________ Contact No.: ______________________________
Address of Establishment: _______________________________________________________________________

Certified by: Signature of Applicant/Owner

FIRE SAFETY INSPECTION


Costumer Relations Officer FEE ASSESSMENT:
Time and Date Received:

Important Notice: As per Sec. 12 of the IRR of the Fire Code of 2008, certain establishments (e.g. building lessors, fire, earthquake, and explosion hazard insurance
companies, and vendors of fire fighting equipment, appliances and devices) may be required to pay additional charges and fees other than the Fire Safety Inspection
Fees. These shall be collected during inspections or in another process to be communicated by representatives of the Bureau of Fire Protection (BFP)

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