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FPIP VEHICLE APPLICATION FORM

Control No. ________________


Brgy. Sta. Anastacia Sto. Tomas, Batangas Tel. Nos.: (043) 405-6020 to 23 Fax No.: (043) 405-6031

VEHICLE PASS / STICKER APPLICATION FORM I. To be filled up by applicant:


a. VEHICLE USER INFORMATION Locator : ___________________________ Gen-contractor Sub-contractor : _________________________ : _________________________

Service Provider : ___________________________


(includes manpower agencies, locator canteen operators, haulers, trucking, etc.)

Name of Designated Driver (s) Project Name / Scope of Work

: ____________________________________________________________ : __________________________________________________________________
Start: __________________ (mm/dd/yy) Finish: _________________ (mm/dd/yy) (up to current year only)

DURATION OF PROJECT / SERVICE:


b.

VEHICLE INFORMATION: (Please check the appropriate box) Plate No. : __________________ Brand Car : __________________ Van Trucks Color : __________________

b.1 Type b.1 # of Wheels b.3 Vehicle owned by

Motorcycle 2 wheels Employer

Others : _______________ Others : _______________ Others : _______________

4 wheels 6 wheels 10 wheels Spouse Relatives _____________

c. APPLICANTS UNDERTAKING
I hereby bind myself and agree to follow all FPIP park rules and regulations and that upon sale or disposal of my vehicle, the vehicle pass / sticker is considered void and revoked. I further certify that all information declared herein are true and correct to the best of my knowledge. _________________________________________ Signature over printed name of applicant

II. To be filled up by Locators:


a. LOCATORS CERTIFICATION AND UNDERTAKINGS:
I hereby certify the following: (1) that the applicant is a bonafide employee / contractor / subcontractor / service provider / supplier / guest of our company; (2) that the driver was fully briefed and agrees to follow all FPIP rules and regulations; (3) that we will take responsibility in ensuring all cases are settled in the event that the vehicle is involved in an accident and / or cause damage inside the park; (4) that the vehicle in the absence of deed of sale traceability is in applicants legal possession; (5) that all information declared herein are true and correct to the best of my knowledge.

Locators Name

Printed Name and Signature of Authorized Signatory

Official Designation

III. To be filled up by FPIP:


PR No. : ________________ Control # : __________________

For the application of: (Please check the appropriate box) Locator Sticker Locator Guest Pass a. FPIP APPROVAL Contractor / Subcontractors / Service Provider Vehicle Pass
(for 4 wheels and above)

Contractor / Subcontractors / Service Provider Vehicle Sticker


(for motorcycles)

____________________________________ OPERATIONS MANAGER / DATE

IV. Requirements:
A. BASIC 1. Photocopy of Certificate of Registration ( CR ) 2. Photocopy of Official Receipt ( Current ) 3. Photocopy of Driver's License ( Valid and Current ) 4. Photocopy of Company ID ( Valid and Current, front and back ) B. OTHERS 5. Photocopy of Deed of Sale ( if applicant is not registered owner ) 6. Copy of lease purchase agreement or lease/rental agreement ( if applicable ) 7. Copy of shuttle service contract ( if Shuttle Service of Locator ) 8. Valid Business Permit ( if Canteen Operators ) Note: 1. 2.

Vehicle Inspected by: Date: Remarks:

Applications will not be received by FPIP with incomplete / insufficient requirements. Other documents may be required by FPIP depending on nature of application.

Rev. 12 (OPN-PF-SEC) 12-01-11

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