DOLEBWCIP3

RepublicofthePhilippines

DEPARTMENTOFLABORANDEMPLOYMENT
NationalCapitalRegion

RegistryofEstablishments

Seriesof___________
ApplicationNo.______

1a.BusinessName:________________________________________________________EIN
1b.RegisteredName:______________________________________________________
1c.TaxIdentificationNumber(TIN):___________________________________________

2.Address:_________________________________________________________________
Floor/Bldg.No./Street/SubdivisionBrgy./City/MunicipalityProvinceZipCodeGEOCODE

3.TelephoneNo.

4.FaxNo.

5.EmailAddress:

6.NameofManager/Owner

7.MainEconomicActivity:____________________________________________________PSIC
MajorProducts/GoodsorServices:___________________________________________Code

8.LegalOrg
anization(CheckAppropriateBox)
SingleProprietorship
Partnership
GovernmentCorporation
PrivateCorporation
Others.Specify_________________________

9.EconomicOrganization(CheckAppropriateBox)

SingleEstablishment
BranchOnly
Establishmentandmainoffice
MainOfficeonly
Ancillaryunit(exceptmainoffice)

10.TotalEmployment:_________Regular:____________NonRegular:_________
Male:____________AlienWorkers:______________Minors:Below15yearsold:___________
Female:__________16below18yearsold:________

11.TotalNumberofSubcontractors:____________________
12.TotalNumberofSubcontractedEmployees:
___________

13.TechnicalInformation(Checkandenumerateaspossible)
Machinery,EquipmentandOtherDevicesinUse

CircularsawMachineDrillPressBoilerPressureVesselInternalCombustionEngine

EngineDieselGasolineOthers,specify_______________________
MaterialsHandlingEquipment

PowerTrucksHandTrucksConveyorsForkliftCranesOthers,specify_______

ChemicalorSubstancesUsedorHandled:___________________________________

ForUpdatingpurposes,accomplishalso:
14.IfnameofEstablishmenthasbeenchanged,stateformername:_____________________________________________
15.IflocationofEstablishmenthasbeenchanged,state formeraddress:__________________________________________

_______________________________________________________________

Floor/Bldg.No./Street/SubdivisionBrgy./City/MunicipalityProvinceZipCodeGEOCODE

CERTIFICATION

Thisistocertifyastotheaccuracyofthedataprovidedinthisform:
Name/SignatureofPersonAccomplishingtheForm:
Position:
TelephoneNo.:

DateFiled:____________________ DateApproved:____________

FaxNo.:
EmailAddress:
Approvedby: