Annex 2: BPLS Unified Form

Application Form for Business Permit

TAX YEAR_____________
MUNICIPALITY OF ODIONGAN
Province of Romblon

Reminder: Fill all necessary information. Renew your business on or before the 20th day of January of the succeeding year to avoid penalty
New Amendment: Mode of Payment
Renewal From Single to Partnership Annually
Additional From Single to Corporation Bi-Annually
From Partnership to Single Quarterly
Transfer From Partnership to Corporation
Ownership From Corporation to Single
Location From Corporation to Partnership
Date of Application: DTI/SEC/CDA Registration No.:
Reference No.: DTI/SEC/CDA date of registration
Type of Organization: Single Partnership Corporation Cooperative CTC No. TIN:
Are you enjoying tax incentive from any Government Entity? ( ) YES ( ) NO Please specify the entity
Number of Taxpayer
Last Name First Name Middle Name
Business Name Birthdate Civil Status
Trade Name/Franchise:
Name of President/Treasurer of corporation:
Last Name First Name Middle Name
Business Address Owner's Address
House No./Bldg. No. House No./Bldg. No.
Building Name Building Name
Unit No.
Street Street
Barangay Barangay
Sitio/Subdivision Subdivision
City/Municipality City/Municipality
Province Province
Tel. No. Tel. No.
Email Address Email Address
Property Index Number (PIN): Total No. of Employeess in Establishment # of Residing in LGU:
Business Area (in sq. m): Average Annual Salary: Male Female:
If Place of Business is Rented, please identify the following: Lessor's Name Monthly Rental:
Last Name First Name Middle Name
Lessor's Address
House No./Bldg. No. Subdivision
Street City/Municipality
Barangay Province
Tel. No. Email Address:
In case of Emergency Contact Person:
Tel. No.: Mobile No. Email Address:
Business Activity Gross Sales / Receipts (for renewal)
No. of Units Capitalization (for new business)
Code Line of Business Essential Non-essential

Oath of Undertaking:
I undertake to comply with the regulatory requirement and other deficiencies within 30 days from release of the business permit.

SIGNATURE OF APPLICANT OVER PRINTED NAME: POSITION/TITLE

 SWORN DECLARATION OF GROSS SALES

Republic of the Philippines )

Province of Romblon )
Municipality of Odiongan )

I, ____________________________________, of legal age, _____________ (Civil Status), residing at

__________________________________________ and operator/owner of
________________________________________________( name of registered business establishment), after
being sworn in accordance with law, depose and say that:

1. I receive professional / talent / service fees / gross revenue as ________________________

(please check box/es) and indicate amount:

 Practice of Profession ___________  Retailer of Essential Commodities ____________

 Retailer of Non-essential Commodities ___________  Non-profit/Cooperative/Educational ____________
 Contractor/Independent Contractor ___________  Dormitory/Boarding House Operator ___________
 Other Kinds/Independent Contractor __________  Real Estate Lessor ____________
 Banks/Other Financial Institution ___________  Miller/Grinder of Essential Commodities _________
 Retailer of Liquors/Wine/Spirits ___________  Retailer of Cigarette/Tobacco ____________
 Wholesaler of Liquors/Wine/Sprits ___________  Wholesaler of Cigarette/Tobacco ____________
 Wholesaler/Dealer/Manufacturer of Essential Commodities ______________
 Wholesaler/Dealer/Maufacturer of Non-Essential Commodities ______________
 Proprietor/Operator of Amusement Place/Devices ______________
 Others: Specify:________________________________________ ______________

2. I am executing this declaration as a requirement for securing my business/mayor’s permit.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________,2020, in the municipality of
__________________________, province of _____________________, Philippines.

Affiant – Declarant
TIN:_______________

SUBSCRIBED AND SWORN to before me in _____________, this ______ day of ___________________

with Community Tax Certificate number: ________________, issued at __________________________, on
________________, 20___.

___________________________
Administering Officer