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Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT


National Capital Region

APPLICATION FOR REGISTRATION OF JOB / SERVICE CONTRACTOR / SUB CONTRACTOR

1. Business Name: TIN: ___________________


2. Business Address:
3. Telephone No.: Fax: E-mail:
4. Contact Person / Position:
5. Areas of Operation:
6. Nature of Business:
7. Industries of Operation:
8. Number of Regular Workers: Total: Male: Female:
9. Names, Position and Address of Officers / Staff: (use additional sheet if necessary)
10. Proof of compliance with substantial capital requirement.

Name of Officer / Staff Position Postal Address

Name and Address Nature of Services Number of Description of the Number of


of Clients Business Provided to Personnel Phase of the Employees
Clients Assigned to Contract Covered in each
each client phase
Male Female Male Female

UNDERTAKING:

That I, , Filipino of legal age,


(name) (position)
of after having been duly sworn to in accordance with law,
(company)
do hereby depose and say:
1. That our company shall abide by all applicable laws rules and regulations of the Department of Labor and
Employment;
2. That the remittance / payments to SSS, HDMF, PhilHealth, ECC and BIR have been made during the
reporting period.

In witness whereof, I have hereunto affixed my signature this ____________day of __________________


2017 in the City of __________________________ .

______________________
(Affiant’s Name / Signature)

SUBSCRIBED AND SWORN to before me this ___________________ day of ________________________, 20___


issued at __________________________on _________________________

Doc. No. ___________


Page No.___________ NOTARY PUBLIC
Book No.___________
Series of ___________

Note: All contracts entered into after this registration shall be reported to the DOLE Regional Office on or before the 10 th
day of the month immediately following the date of entry into contract.

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