APPENDIX 1-A MASTER COPY

APPLICATION FOR ACCREDITATION & REGISTRATION

(CORPORATION – PARTNERSHIP – COOPERATIVE)

Intelligence Group (IG)

Account Management Office (AMO)

I, NAME OF RESPONSIBLE OFFICER/ OR PRESIDENT, of legal age, with postal address at

Complete address of the responsible officer, after having been duly sworn in accordance with
law, hereby depose and say that:

1. I am the Position of NAME OF THE COMPANY duly authorized to file this application
for accreditation and registration with the Bureau of Customs, as evidence by the written
authority from the company.

2. I hereby present the following information for accreditation with the Bureau of Customs;

2.1 Name of the Firm ______________Fill out _______________________________

a. Head Office Address ___Fill out_____________________________________
___Fill out_____________________________________
Years of Stay in the premises: _____Fill out____________________________
Nature of Occupation: ____Fill out___________________________________

b. Warehouse Address ____Fill out ____________________________________

_______________________________________________
Years of Stay in the premises: ____Fill out ____________________________
Nature of Occupation: ( ) owned (x ) leased ( ) shared
( ) others ________________________________
c. Branch Office _____n/a____________________________________________

d. Years of Stay in the premises: _____n/a_______________________________

Nature of Occupation: ( ) owned ( ) leased ( ) shared
( ) others ______n/a_______________________

e. Telephone Number/s ___Fill out ____________________________________

f. Facsimile Number/s ___n/a_________________________________________

g. Email Address ___Fill out _____________________________________ ____

h. Number of Employees ___none_____________________________________

i. Nature of Company ____Fill out ___________________________________

j. TIN No. ____Fill out ____________________________________________

*Mandatory Field since Notice of Denial / Approval will be send via Email*
 2.2 List of Officers / Directors (Please attach PERSONAL PROFILE or RESUME)

_____Fill out ___________________________________________________

_____Fill out ___________________________________________________
_____ Fill out __________________________________________________
_____ Fill out ___________________________________________________
_____ Fill out __________________________________________________

3. I hereby attached herewith the following documents:

( ) BCOR evidencing payment of application fee

( ) BIR Importer Clearance Certificate (BIR-ICC)
( ) Corporate Secretary Certificate for designated signatories (with sample original
signatures) in the import entries.
( ) Original copy of NBI Clearance issued within three (3) months prior to the date of
application of responsible officers and majority stockholders.
( ) Two (2) valid government issued I.D., with picture of applicant
( ) Printed CPRS profile of applicant
( ) Latest General Information Sheet
( ) Personal Profile of responsible officers and majority stockholders
( ) Company Profile with pictures of (office and warehouse) premises
( ) License / permit / accreditation from concerned agency, when applicable, i.e., food
(LTO & CPR), rice (NFA), sugar (SRA), etc.
( ) Indorsement from the Collector, if applicable.

4. List of Importable Items with clear description in technical and tariff terms, estimated
volumes and values for the next twelve (12) months (Use separate sheet if necessary).

Commodity Tariff Technical Volume Value

(General Terms) Heading Description

Please see
attached.
REPUBLIC OF THE PHILIPPINES)
______________________________) S.S

SWORN UNDERTAKING

I hereby certify under oath that all the above information are true and correct; all documents
submitted in support of this application are true copies of the original, subject to verification; any
misrepresentation and/or manifestation of fraud in this application shall be a ground for the
disapproval of my application, and blacklisting of our firm and the undersigned as the applicant.

As specified in Section 2.2 of CMO No. 4-2014, I hereby undertake to (a) to receive notice
by e-mail; (b) to strictly abide with existing rules and regulations on the Statement of Full
Description of Imported Articles covered by entry declaration; (c) to notify the BOC-AMO of any
changes in the information contained in the application for accreditation; and (d) to obtain
knowledge of the contents of a declaration, and to attest to the veracity thereof;

I fully understand that failure to comply with the undertaking will result in the cancellation
and revocation of the accreditation as importer, without prejudice to the imposition of any other
criminal sanction for violation of the Tariff and Customs Code of the Philippines, and other
customs laws and regulations.

AFFFIX 2X2 picture of

Incorporator / Applicant
Latest photo, should Very truly yours,
Not be more than 3
Month old
**************************** NAME
APPLICANT’S NAME & SIGNATURE

SUBSCRIBED AND SWORN to before me this ________________ day of

___________________ in Metro Manila, Philippines, affiant exhibiting to me his/her TIN 000-
000-000-000 issued at Metro Manila.

Doc No. ___________

Page No. __________ NOTARY PUBLIC
Book No. __________
Series of 2017.
 PERSONAL PROFILE

COMPLETE NAME: FILL OUT COMPANY POSITION: FILL OUT

DATE OF BIRTH: FILL OUT SEX: FILL OUT

CIVIL STATUS: FILL OUT CITIZENSHIP: FILL OUT

RESIDENCE ADDRESS: FILL OUT

EMAIL ADDRESS: FILL OUT TIN: FILL OUT

ACADEMIC BACKGROUND:

Education Name of Institution Dates of Attendance Degree Received

(Write in Full) (Write in Full)
Primary FILL OUT FILL OUT FILL OUT

Secondary FILL OUT FILL OUT FILL OUT

College FILL OUT FILL OUT FILL OUT

Vocational / Trade FILL OUT FILL OUT FILL OUT

Course
Graduate Studies FILL OUT FILL OUT FILL OUT

EMPLOYMENT HISTORY

INCLUSIVE DATES NAME OF COMPANY POSITION / TITLE

FILL OUT FILL OUT FILL OUT

_____________________________
Date Accomplished
Affix 2x2 latest photo
( not more than 3 months
FILL OUT old)
Printed Name & Signature