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FAIR TRADE ENFORCEMENT BUREAU

Import Regulation Division
UPRC Bldg. VI, 315 Sen. Gil Puyat Avenue
1200 Makati City, Philippines
Tel. No. (632)403-1417
E-mail address: fteb_ird@dti.gov.ph Website: www.dti.gov.ph

APPLICATION FORM
IMPORTATION THROUGH DONATION OF USED MOTOR VEHICLE
BY LOCAL GOVERNMENT UNITS (Under EXECUTIVE ORDER NO. 443)

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
 Date: _________________

A. APPLICANT’S INFORMATION:

NAME OF DONEE/CONSIGNEE:
ADDRESS:
CONTACT PERSON:
TEL. NO./FAX NO/E-MAIL ADDRESS:

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
NAME OF DONOR/SUPPLIER:
ADDRESS:
TEL. NO/FAX NO/E-MAIL ADDRESS:

B. MOTOR VEHICLES TO BE DONATED:

DESCRIPTION TARIFF HEADING QUANTITY ORIGIN

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
C. DESCRIPTION OF MOTOR VEHICLES TO BE DONATED (For Passenger Cars
Only)

Make & Year Model: Date of Registration:

Engine Displacement (cc): Engine No.:

Color: Type of Fuel:

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
Vehicle Identification No.: Gross Vehicle Weight:

____________________________________________
Name and Signature of Authorized Signatory

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
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REPUBLIC OF THE PHILIPPINES )

___________________________ ) S. S.

AFFIDAVIT OF UNDERTAKING

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
 I, ___________________________________ (Signatory), of legal age, married/single and
residing at ____________________________________________________________________after
having duly sworn to in accordance with the law hereby depose and state:

1. That I am the principal signatory of

____________________________________________
(agency/entity);

2. That as a principal signatory, I am authorizing Mr./Ms.

_________________________________ to be my representative;

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
3. That this motor vehicle donation is accepted under Resolution No. _______ of
the Sangguniang Bayan/Panlunsod/Panlalawigan of
_____________________________;
(Name of City, Town,
Province).

4. That we further bind ourselves to answer for any criminal, civil or

administrative case that may arise relative to the aforesaid application.

AFFIANTS FURTHER SAYETH NAUGHT.

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
 ________________________________ ___________________________
Name & Signature of Name & Signature of
Principal Signatory Authorized Representative

________________________________
Designation

SUBSCRIBED AND SWORN TO BEFORE ME, this _______ day of ______________,

201__ (principal and representative) exhibited their Residence Certificate Nos.

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
____________ and _______________ issued at _________________ on ________________ and
at _________ on ________________, respectively.

____________________________
NOTARY PUBLIC

Doc. No.: __________ PTR No.: _________________

Page No.: __________ Valid until ________________
Book No.: __________ Series of _________________

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
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IMPORTATION THROUGH DONATION OF USED MOTOR VEHICLE

BY LOCAL GOVERNMENT UNITS UNDER EXECUTIVE ORDER 443 (S. 2005)

To be accomplished by Donor:
To be accomplished by Donee:

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
 Completely filled-out application  Authenticated DEED OF DONATION
form by the nearest Philippine Consulate
abroad (original and photocopy)
 Letter request for Importation

 Notarized Affidavit of Undertaking

 Three hundred pesos (Php 300.00)

processing fee

CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17
CPG-FTEB-IRD-QF-01G/Rev.01/05.11.17