LA SALLE GREEN HILLS

CANTEEN OPERATION
CONCESSIONAIRES APPLICATION FORM

Procedure:
1. Accomplish this form and submit to the Safety and Security Office (SSO) with required
attachments on or before January 8, 2019.
2. The Canteen Committee will deliberate which concessionaires will be invited for food tasting
and which product/s can be presented.
3. The SSO will then contact the selected concessionaires and schedule the food tasting with the
Canteen Committee.
4. The Canteen Committee will deliberate and choose the concessionaires who will serve the
community for the next School Year. (*please note that the Canteen Committee will also choose
and make the final list of products that may be sold in your stall).
5. The SSO will upon confirmation of the president shall contact you for other requirements and
contract signing.

I. APPLICANTS INFORMATION

Name of Company: LSGH Buko Juice and Shake Station

(Please attach company profile)

Company Address: Del Nacia Ville #3, Quezon City

Company Contact number: 7928448

(PLEASE ATTACH SEC/DTI REGISTRATION; BUSINESS PERMIT; BIR REGISTRATION)

Proprietor/s information:

NAME: Nenita C. Ajero

CONTACT INFORMATION: 7928448

NAME of FSCO (if any): N/A

Food Safety Related Certifications: (HACCP, GMPP, etc – please attach certificates and details *if any):
N/A
Number of years in operation: 6
Schools / companies served: LSGH
 II. PRODUCT INFORMATION

CATEGORY
Under what category are you applying for (Tick 1):
Pasta/Noodles Sandwiches/Wraps/Bread Assorted Finger Foods
Drinks/Beverages

PRODUCT DETAILS

(Please add rows if necessary)

Product name and DETAILED ingredients General Process Price (and

details including brand/source (Specific process size if
(lacking details might shall be disclosed applicable)
disqualify the product) by accepted
concessionaires
before contract
signing)
Fresh Buko Juice Fresh Buko Water Mix all ingredients S – 32
Fresh Buko Meat M – 40
Crushed Ice L - 60
Buko Shake Fresh Buko Meat Mix all incredients S – 42
Crushed Ice in a blender. M – 50
Evaporated Milk L - 70
Brown Sugar

By signing this APPLICATION FORM, you agree with all terms and conditions related to the application. You further commit to abide by all
policies including those that would be implemented in the future. This also signify that you have read and agree with the policies for the
canteen selection. Lastly, you consent to the processing of your information for LSGH to document those who have applied, accessed and
served the community. We will treat your information in the strictest confidence and will implement security measures to safeguard your
information. Information of those selected to be concessionaires will be dispose after one (1) school year thru shredding. Unfortunate
applicants’ forms shall be shredded once we have selected and finalized the list of concessionaires.

NENITA C. AJERO
_________________________________________
SIGNATURE OVER PRINTED NAME OF APPLICANT