ANNEX A-1

ANNEX A-1

APPLICATION FORM FOR ACCREDITATION OF

Note: To be accomplished and signed by an individual applicant or by an authorized officer of a non-individual

applicant.
PLEASE CHECK APPLICABLE BOX:

INDIVIDUAL APPLICANT

NON-INDIVIDUAL APPLICANT

NAME
OF
APPLICANT:
_______________________________________________________________________________________
DTI-REGISTERED
BUSINESS
NAME
(IF
ANY):
______________________________________________________________________
TAXPAYER
IDENTIFICATION
NUMBER
(TIN):
_________________________
EMAIL
ADDRESS:
_______________________________
RESIDENTIAL
ADDRESS:
______________________________________________________________________________________
________________________________________________________________ CONTACT
NO:
______________________________
PRINCIPAL
PLACE/HEAD
OFFICE
OF
BUSINESS
ADDRESS:
___________________________________________________________
________________________________________________________________ CONTACT
NO:
______________________________
LINE OF BUSINESS: ___________________________________________________________________PSIC:
__________________
NAME
OF
AUTHORIZED
OFFICER
(FOR
NON-INDIVIDUAL
APPLICANTS):
________________________________________________
POSITION/DESIGNATION:
____________________________________
TIN:
____________________________________________
ENCLOSED ARE THE FOLLOWING SUPPORTING DOCUMENTS TO THIS APPLICATION (PLEASE CHECK):
____ CERTIFIED TRUE COPY OF THE LATEST BIR CERTIFICATE OF REGISTRATION OF PRINCIPAL
PLACE/HEAD OFFICE OF BUSINESS AND OF ANY BRANCH/FACTILITY
____ AUTHENTICATED COPY OF LATEST ANNUAL INCOME TAX RETURN (WITH ATTACHMENTS)
____ CERTIFIED TRUE COPY OF LATEST MAYORS BUSINESS PERMIT OR DULY RECEIVED APPLICATION
FOR SUCH PERMIT
____ PROOF OF OWNERSHIP/LAWFUL OCCUPANCY OF PRINCIPAL PLACE/HEAD OFFICE OF BUSINESS
____ VICINITY MAP, LOCATION PLAN AND PHOTOGRAPHS OF PRINCIPAL PLACE/HEAD OFFICE OF
BUSINESS
(SUBJECT TO ADDITIONAL REQUIREMENTS FOR SPACE-SHARING ARRANGEMENTS)
____ PHOTOCOPY OF LATEST UTILITY BILLS FOR THE PRINCIPAL PLACE/HEAD OFFICE OF BUSINESS
____
UNDERTAKING TO COMPLY WITH THE DUTY TO PRESERVE AND MAINTAIN RECORDS FOR A
PERIOD OF TEN (10) YEARS AND TO ALLOW ACCESS TO EXAMINATION BY THE BIR, BOC, AND THE
DOF-FIU
____ PHOTOCOPY OF THE OFFICIAL RECEIPT FOR THE PAYMENT OF THE BIR ACCREDITATION
PROCESSING & CERTIFICATION FEE
ADDITIONAL REQUIREMENTS FOR INDIVIDUAL APPLICANTS:
____
CERTIFIED TRUE COPY OF DTI CERTIFICATE OF REGISTRATION OF BUSINESS NAME (IF A
BUSINESS TRADE NAME IS USED)
____ ORIGINAL COPY OF PERSONAL PROFILE WITH TWO (2) RECENT 2X2 PICTURES (FOR INDIVIDUAL
APPLICANTS)
ADDITIONAL REQUIREMENTS FOR NON-INDIVIDUAL APPLICANTS:
____ CERTIFIED TRUE COPY OF SEC REGISTRATION AND ARTICLES OF INCORPORATION/ARTICLES OF
PARTNERSHIP
____ CERTIFIED TRUE COPY OF LATEST GENERAL INFORMATION SHEET FILED WITH THE SEC
____
CERTIFIED TRUE COPY OF COOPERATIVE DEVELOPMENT AUTHORITY (CDA) CERTIFICATE OF
REGISTRATION AND ARTICLES OF COOPERATION
____ ORIGINAL COPY OF THE CERTIFICATE OF GOOD STANDING ISSUED BY THE SEC OR THE CDA
____ ORIGINAL COPY OF THE PROFILE OF THE CORPORATION, PARTNERSHIP, COOPERATIVE OR
ASSOCIATION
____ ORIGINAL COPY OF THE PROFILE OF EACH MEMBER OF THE BOARD, CORPORATE OFFICERS,
PARTNERS

ANNEX A-1
____ ORIGINAL COPY OF THE PROFILE OF EMPLOYEES, REPRESENTATIVES OR AGENTS DEALING WITH
THE BUREAU OF CUSTOMS
____ ORIGINAL COPY OF THE SECRETARYS CERTIFICATE OF THE MINUTES/CONTENTS OF THE BAORD
RESOLUTION AUTHORIZING THE DESIGNATED REPRESENTATIVE TO SIGN THIS APPLICATION
I HEREBY DECLARE, UNDER THE PENALTIES OF PERJURY, THAT THIS APPLICATION HAS BEEN
MADE IN GOOD FAITH, AND THAT THE REPRESENTATIONS INCUDING THE ACCOMPANYING SUPPORTING
DOCUMENTS HAVE BEEN VERIFIED BY ME AND TO THE BEST OF MY KNOWLEDGE, BELIEF, AND
INFORMATION ARE CORRECT, COMPLETE AND TRUE.
____________________________________________
___
Signature over Printed Name of
Individual Applicant/
Authorized Officer of Non-Individual Applicant
SUBSCRIBED AND SWORN to before me this ______ day of ________________ 20___ in
_______________________________, applicant exhibiting to me his/her competent evidence of identity (governmentissued identification) No. ____________, bearing his photograph and signature, issued on __________ by
____________ at _____________.

NOTARY PUBLIC