Republic of the Philippines

Department of Labor and Employment

Regional Office No. ___
PRIVATE EMPLOYMENT AGENCY LICENSE
APPLICATION FORM
Please read the instructions carefully before filling up this application form.

Transaction Type New Domestic Workers

Renewal Industry
To avoid delay, strictly no erasures and supply
Both all data and necessary documents.
Type of Business Registration:
Sole Partnership Corporation

BUSINESS DETAILS
Net Worth/Paid-up Capital:
Name of Agency:

Address of Agency: Contact Details:

Owned Leased PEA License No.:

No. of Employee/s: DTI/SEC Registration No.: TIN:
Website Address (if applicable):
Social Media Accounts: Other/s:

Name of President/Owner:
Last Name First Name Middle Name Name Extension (Sr., Jr., etc)
Contact details: Citizenship:
Civil Status: Single Married Widowed Others: _____________ Sex: Male Female
MANAGEMENT AND STAFF
Name Designation Address Contact No. Email

UNDERTAKING

In witness whereof, I have hereunto affixed my signature this _____________ day of _____________________________, 20___ in
_______________________________________________.

_______________________________________
(Applicant’s Name, Position and Signature)

SUBSCRIBED AND SWORN to before me this ______ day of ______________, 20____ in _________________, Applicant exhibiting to me
his/her government-issued ID _________ issued at _______________________ on _______________________.

NOTARY PUBLIC

Doc. No. __________ Book No. __________

Page No. __________ Series of __________

FOR DOLE USE ONLY

Received By: Reviewed By:

Name and Designation/Date Name and Designation/Date

Approved By:
Receipt No.: ______________________

Date of Issuance: ______________________

Regional Director/Date Issued by: ______________________

List of Documentary Requirements

The applicant for license to operate a PEA shall submit a duly accomplished application form together with the complete requirements, as applicable:

Valid NBI Clearance of the applicant owner, or the partners in case of partnership, or in case of corporation, its officers and directors;
Certified True Copies (CTCs) of the Certificate of Business Name Registration and original application form from the Department of Trade and Industry
for single proprietorships; or CTCs of the Articles of Partnership, Certificate of Incorporation and By-Laws from the Securities and Exchange
Commission and updated General Information Sheet (GIS) for partnerships and corporations;
Documentary proof of ownership: Transfer Certificate of Title or Contract of Lease of an office space with at least forty (40) square meters floor area
for the exclusive use of the agency. In case of lease, the contract must be for a period of at least one (1) year with an option for renewal;
Certificate of participation/attendance by the owner, partners, president, general managers, or agency’s management representative to the Pre-
Application Orientation (PAO);
Certificate of No Pending Case from the Department of Labor and Employment;
Notarized Affidavit of Undertaking; and
Notatized statement of assets, liabilities, and net worth (SALN) or an audited financial statement duly received by the Bureau of Internal Revenue for
the net worth; or Articles of Parnerships or Incorporations and CTC of GIS for the paid-up capital.
Mayor's permit (for renewal)
For more information visit www.ble.dole.gov.ph Revised as of 06 December 2021
 Republic of the Philippines
Department of Labor and Employment
Regional Office No. ___
APPLICATION FOR AMENDMENTS

Please read the instructions carefully before filling up this application form.
Transaction Type Change of Ownership
Change of Address
Change of Authorized Representative To avoid delay, strictly no erasures and
supply all data and necessary documents.
Type of Business Registration:
Sole Partnership Corporation

BUSINESS DETAILS
Name of Agency: PEA License No.:
Contact Details:
Address of Agency:

Website Address (if applicable):

Social Media Accounts: E-mail:
Others

Type of Agency: Industry Kasambahay Both

Change of Ownership
- Please take note that change or transfer of ownership of a single proprietorship shall cause the automatic revocation of license (based on Art. III Sec. 7 of both DO 216 and 217).
- In case of more than one owner to be changed, please accomplish separate form per person.

PREVIOUS NEW
Name of Owner: Name of Owner:
Percentage of Share: Percentage of Share:
Amount of Share Capital: Amount of Share Capital:
Contact Details: Contact Details:
Address (Personal Address): Address (Personal Address):
Position in PEA (if any): Position in PEA (if any):
TIN: TIN:
Sex: Sex:
Civil Status: Civil Status:
Citizenship: Citizenship:
Reason for Change of Ownership:
Sold Shares Deceased Owner / Part-Owner Others (please specify) _______________________________
Change of Authorized Representative
PREVIOUS NEW
Name: Name:
Address (Personal Address): Address (Personal Address):

Contact Details: Contact Details:

Sex: Civil Status: Sex: Civil Status:
Citizenship: Citizenship:
Change of Address
Within the same Region: Yes No
PREVIOUS NEW
Address of Agency: Address of Agency:

Owned Leased Owned Leased

Other Pertinent Changes (please write the updated details if there is any)

FOR DOLE USE ONLY

Received By: Reviewed By:

Name and Designation/Date Name and Designation/Date

Approved By:
Receipt No.: ______________________

Date of Issuance: ______________________

Regional Director/Date Issued by: ______________________

List of Documentary Requirements

The applicant for change of ownerhip/ transfer of address shall submit a duly accomplished application form together with the complete requirements, as
applicable:*Valid NBI Clearance of the applicant owner, or the partners in case of partnership, or in case of corporation, its officers and directors;
board resolution/secretary's certificate of election, and letter of appoinrtment/contract of employment;
Notification letter to the DOLE Regional Office with a request for reprinting of the license;
Documentary proof of ownership, such as Transfer Certificate of Title or Contract of Lease of an office space with a floor area of at
least forty (40) square meters for the exclusive use of the agency. In case of lease, the contract must be for a period of at least one (1)
year with an option for renewal;
Location map and pictures of the new office for validation of agency office space;
Updated surety bond;
Amended Articles of Incorporation or Partnership, in case of corporation or partnership; and
Proof of publication of new address in conspicuous places, newspaper of local or general circulation or posting in LGU-PESO
concerned.

* for change of ownership/authorized representative

For more information visit www.ble.dole.gov.ph Revised as of 06 December 2021

 Republic of the Philippines
Department of Labor and Employment
DOLE Regional Office No. __
AUTHORITY TO RECRUIT
APPLICATION FORM
Please read the instructions carefully before filling up this application form.
To avoid delay, strictly no erasures and
Type of Business Registration: Sole Partnership Corporation supply all data and necessary
documents.
BUSINESS DETAILS
Name of Agency:
Contact Details:
Address of Agency:
Email Address:
Email Address:
PEA License No. No. of Employee/s:

Website (if applicable) TIN:

Social Media Accounts: Other/s:

Name of President/Owner: Last Name First Name Middle Name Name Extension (Sr., Jr., etc)
Contact details: Citizenship:
Civil Status: Single Married Widowed Others: _____________

Sex: Male Female Email Address:

COMPREHENSIVE DESCRIPTION OF ACTIVITY: (Please indicate if providing domestic workers or industry workers.)
Domestic Workers Industry
Place of Recruitment:
Date and Time:
Other Details:

MANAGEMENT AND STAFF

Name Designation Address Contact No. Email

UNDERTAKING

I hereby declare that I have accomplished this form to the best of my knowledge which is true and correct pursuant to the
provisions of Labor Code, as amended and pertinent laws, rules and regulations. I authorize the agency head/authorized
representative to verify/validate and share with the concerned government agency/ies the contents stated herein. I agree
that any misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s
against me.

_________________________________________
(Signature over Printed Name/Date)

FOR DOLE USE ONLY

Received By: Reviewed By:

Name and Designation/Date Name and Designation/Date

Approved By:
Receipt No.: ______________________

Date of Issuance: ______________________

Regional Director/Date Issued by: ______________________

List of Documentary Requirements

The application for Authority to Recruit shall only be processed upon submission of the duly accomplished application form with complete
requirements to the Regional Office having territorial jurisdiction over the place where the recruitment activity will

Letter request by the agency indicating the exact date and venue of the recruitment activity as well as the names of designated representative;
Certified true copy of valid PEA license;
NBI Clearance of the authorized representative/s; and
Certificate of No Pending Case from the Department of Labor and Employment.

For more information visit www.ble.dole.gov.ph Revised as of 06 December 2021

 Republic of the Philippines
Department of Labor and Employment
DOLE Regional Office No. __
AUTHORITY TO OPERATE BRANCH OFFICE
APPLICATION FORM
Please read the
Transaction Typeinstructions carefully before filling up this application form.
New Renewal To avoid delay, strictly no
erasures and supply all data
Type of Business Registration: Sole Partnership Corporation and necessary documents.
BUSINESS DETAILS

Name of Agency:
Contact Details:
Address of Agency:
Email
Email Address:
Address:
PEA License No. No. of Employee/s:

Website (if applicable) TIN:

Social Media Accounts: Other/s:

Name of President/Owner: Last Name First Name Middle Name Name Extension (Sr., Jr., etc)
Contact details: Citizenship:

Civil Status: Single Married Widowed Others: _____________

Sex: Male Female Email Address:

COMPREHENSIVE DESCRIPTION OF OPERATION: (Please indicate if providing domestic workers or industry workers.)
Domestic Workers Industry
Address of Branch Office:
Branch Office Manager:
Other Important Details:

MANAGEMENT AND STAFF

Name Designation Address Contact No. Email Address

UNDERTAKING

I hereby declare that I have accomplished this form to the best of my knowledge which is true and correct pursuant to the
provisions of Labor Code, as amended and pertinent laws, rules and regulations. I authorize the agency head/authorized
representative to verify/validate and share with the concerned government agency/ies the contents stated herein. I agree that any
misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s against me.

_________________________________________
(Signature over Printed Name/Date)

FOR DOLE USE ONLY

Received By: Reviewed By:

Name and Designation/Date Name and Designation/Date

Approved By:
Receipt No.: ______________________

Date of Issuance: ______________________

Regional Director/Date Issued by: ______________________

List of Documentary Requirements

The application for Authority to Operate Branch Office shall only be processed upon submission of the duly accomplished application form
with complete requirements and payment of fees, as follows:

Certified true copy of the valid PEA license;

Organizational structure of the branch office, including names of manager and staff members;
NBI clearance of the branch manager and staff members; and
Transfer Certificate of Title or Contract of Lease

For more information visit www.ble.dole.gov.ph Revised as of 06 December 2021