REPUBLIC OF THE PHILIPPINES

BATANGAS CITY
BUSINESS PERMITS AND LICENSING OFFICE
Application Form for Business
TAX YEAR ________
Instructions
1. Provide accurate information and print legibly to avoid delays. Incomplete application form will be returned to the applicant.
2. Ensure all documents attached to this application form are complete and properly filled out.
3. For corporation, only responsible person (President, Chief Accountant and Corporate Secretary) should sign the form.
In case of Liaison Officer or any authorized representative, please kindly present an authorization letter signed by the
identified responsible person of the corporation .
Business Permit No._____________________(for renewal) New Mode of Payment
Business Plate No. Renewal Annually Bi-Annually Quarterly
Date of Application Registration No.
DTI Date of Registration
Date of Expiry
Business Type Single Proprietorship Registration No.
Partnership SEC Date of Registration
Corporation Date of Expiry
Business Classification (micro, small, etc.) Registration No.
CDA Date of Registration
Date of Expiry
For Single Proprietorship Name of Registrant
Last Name First Name Middle Name Suffix Name

Date of Birth: TIN:

Trade Name:
Doing Business As (DBA):
Franchise:
For Partnership Name of Registrant
Last Name First Name Middle Name Suffix Name Date of Birth TIN

For Corporation/Cooperative
Complete Business Name:
Name of CORPORATION/COOPERATIVE:
Name of Registrant:
Address:
Tel. No./E-mail address: TIN:
Are you enjoying tax incentive from any government entity? ( ) Yes ( ) No Please specify the entity: ______________________________
Owners Address: Complete Business Address:
House No./Bldg. No. House No./Bldg. No.
Building Name Building Name
Unit No. Unit No.
Street Street
Barangay Barangay
Subdivision Subdivision
City/Municipality Office Landline
Province Fax Number
Postal Code E-mail address
Residential Line In case of emergency, contact person/Tel.No./Mobile No.:
Mobile No.
E-mail address
Business Area (in sqm.) Total No. of Employees in Establishment Total No. of Employees Residing in Batangas City
Male: Female:
In case Place of Business is rented, complete this section:
Lessors Name: Last Name First Name Middle Name Monthly Rental

Lessors Complete Address:

No. Street Subd. Brgy. City Province

E-mail address: Tel. No.

Lessors Date of Birth: Lessors TIN:
 Business Activity
Branch Line of Business No. of Units Capitalization Gross/Sales Receipts
(for New Business) (for Renewal)

I DECLARE UNDER PENALTY OF PERJURY that the foregoing information are true based on my personal knowledge and authentic records.

SIGNATURE OF APPLICANT OVER PRINTED NAME

POSITION/TITLE

For City Assessors:

VERIFICATION OF DOCUMENTS
Description Office/Agency Verified by: Remarks
Barangay Business Clearance Barangay
Market Clearance (for Market Stall Holders only) Office of the City Market Administrator
Cert. of Envtl. Permit to Operate/City Environmental Cert. City Environment and Natural Resources Office
Veterinary Clearance and Certification Office of the City Veterinary and Agricultural Services
Sanitary Permit/Health Certificate City Health Office
Fire Safety Inspection Certificate Batangas City Fire Station
Others, please specify:

Application checked by: BPLO

ASSESSMENT:
Treasurers Office ___
Business Tax and Fees Division ___
Latest Payment ___

For the BATANGAS CITY FIRE STATION:

APPLICATION NO.: R4A-B_______________ DATE:

(To be filled up by applicant/owner)
Name of Applicant/Owner:
Name of Business:
Total Floor Area: _______ Contact No.:
Address of Establishment:

_______
Signature of Applicant/Owner

Compliance Checklist for Assessment of Fire Safety Inspection Certificate (FSIC) for BUSINESS:
(To be checked/filled up by the Customer Relations Officer)
ASSESSMENT:
Occupancy Permit (if applicable) Fire Code Realty Tax:
Previous Fire Safety Inspection Certificate (FSIC) (if applicable) Fire Code Premium Tax:
Photocopy of Fire Insurance Policy (if applicable) Fire Code Sales Tax:
Fire Safety Inspection Fee:
Storage Clearance Fee:
Fire Code Admin Fine:
Others:
Total:

Certified by:

Customer Relations Officer Time and Date Received: _________________