Form VC BPO1

NEW RENEWAL ADDITIONAL QUARTERLY SEMI-ANNUALY ANNUALY

Republic of the Philippines

CITY GOVERNMENT OF VALENZUELA

Metropolitan Manila

DATE MAYORS PERMIT NO.

REQUIREMENTS: NEW BUSINESS: 1. Barangay Clearance 2. Community Tax Certificate (Cedula) 3. Sketch of Business Location All other requirements required by law, ordinance and rules are subject to Pos-Audit process. RENEWAL:
1. 2. 3. Barangay Clearance (2011) Community Tax Certificate (Cedula) 2011 Previous permit and application

BUSINESS TRADE NAME

TEL. NO.

BUSINESS ADDRESS NAME OF TAXPAYER

HOUSE NO. SURNAME

STREET NAME FIRST NAME MIDDLE INITIAL

BARANGAY TEL. NO.

ADDRESS OF TAXPAYERS

HOUSE NO.

STREET NAME

BARANGAY

CITY/MUNICIPALITY

NAME OF PRESIDENT / CEO / MANAGER

SSS NO.:

TIN NO.:

COMMUNITY TAX CERTIFICATE NO.: (INDIVIDUAL OR CORPORATE) IF TRANSFER OF OWNERSHIP FROM WHOM ACQUIRED: CODE LINE OF BUSINESS/ACTIVITIES

DATE ISSUED:

PLACE ISSUED:

GROSS SALES/RECEIPTS

CAPITAL INVESTMENT SUBSCRIBED PAID-UP

TOTAL NO. OF EMPLOYEES/ WORKERS

TOTAL NO. OF EMPLOYEES/ WORKERS FROM VALENZUELA

DELIVERY TRUCKS/VANS/VEHICLES NO. OF UNITS

STORAGE OF FLAMMABLES NO. OF GALLONS: IF PLACE OF BUSINESS IS RENTED / NOT OWNED

ESTIMATED AREA USED IN BUSINESS

NAME OF OWNER: ADDRESS: ADMINISTRATOR: (If name of owner is not available) RENT START: (Month/Year) RENT PER MONTH: TO BE FILLED UP BY NEW APPLICANT ONLY % OF ALIEN CAP INVESTMENT PARTNERSHIP CORPORATION DATE OF ISSUE: DATE OF ISSUE: CERTIFICATE OF OCCUPANCY NO: BOI REG. NO.: DATE OF ISSUE: DATE OF ISSUE:

KIND OF OWNERSHIP SINGLE PROPRIETORSHIP LOCATIONAL CLEARANCE NO.: SEC. REG. NO.:

DTI REG. NO.:

DATE OF ISSUE:

CDA REG. NO.:

DATE OF ISSUE:

TO BE FILLED UP BY PROCESSOR/ASSESSOR ENDORSEMENTS: OFFICE HEALTH DEPARTMENT

FIRE/ELECTRICAL DEPARTMENT DATE ENDORSED DATE RELEASED

OFFICE

DATE ENDORSED

DATE RELEASED

ENGINEERING DEPARTMENT/ BUILDING OFFICAL

POLICE DEPARTMENT

DEED OF UNDERTAKING/WAIVER
I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all the requirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirements and in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation of my business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents and purposes. IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

SIGNATURE OF APPLICANT/REPRESENTATIVE POSITION/TITLE

APPROVED BY:

CHIEF - BPLO

SHERWIN T. GATCHALIAN
CITY MAYOR

TAXPAYERS COPY

Form VC BPO1
NEW RENEWAL ADDITIONAL QUARTERLY SEMI-ANNUALY ANNUALY

Republic of the Philippines

CITY GOVERNMENT OF VALENZUELA

Metropolitan Manila

DATE MAYORS PERMIT NO.

REQUIREMENTS: NEW BUSINESS: 1. Barangay Clearance 2. Community Tax Certificate (Cedula) 3. Sketch of Business Location All other requirements required by law, ordinance and rules are subject to Pos-Audit process. RENEWAL:
1. 2. 3. Barangay Clearance (2011) Community Tax Certificate (Cedula) 2011 Previous permit and application

BUSINESS TRADE NAME

TEL. NO.

BUSINESS ADDRESS NAME OF TAXPAYER

HOUSE NO. SURNAME

STREET NAME FIRST NAME MIDDLE INITIAL

BARANGAY TEL. NO.

ADDRESS OF TAXPAYERS

HOUSE NO.

STREET NAME

BARANGAY

CITY/MUNICIPALITY

NAME OF PRESIDENT / CEO / MANAGER

SSS NO.:

TIN NO.:

COMMUNITY TAX CERTIFICATE NO.: (INDIVIDUAL OR CORPORATE) IF TRANSFER OF OWNERSHIP FROM WHOM ACQUIRED: CODE LINE OF BUSINESS/ACTIVITIES

DATE ISSUED:

PLACE ISSUED:

GROSS SALES/RECEIPTS

CAPITAL INVESTMENT SUBSCRIBED PAID-UP

TOTAL NO. OF EMPLOYEES/ WORKERS

TOTAL NO. OF EMPLOYEES/ WORKERS FROM VALENZUELA

DELIVERY TRUCKS/VANS/VEHICLES NO. OF UNITS

STORAGE OF FLAMMABLES NO. OF GALLONS: IF PLACE OF BUSINESS IS RENTED / NOT OWNED

ESTIMATED AREA USED IN BUSINESS

NAME OF OWNER: ADDRESS: ADMINISTRATOR: (If name of owner is not available) RENT START: (Month/Year) RENT PER MONTH: TO BE FILLED UP BY NEW APPLICANT ONLY % OF ALIEN CAP INVESTMENT PARTNERSHIP CORPORATION DATE OF ISSUE: DATE OF ISSUE: CERTIFICATE OF OCCUPANCY NO: BOI REG. NO.: DATE OF ISSUE: DATE OF ISSUE:

KIND OF OWNERSHIP SINGLE PROPRIETORSHIP LOCATIONAL CLEARANCE NO.: SEC. REG. NO.:

DTI REG. NO.:

DATE OF ISSUE:

CDA REG. NO.:

DATE OF ISSUE:

TO BE FILLED UP BY PROCESSOR/ASSESSOR ENDORSEMENTS: OFFICE HEALTH DEPARTMENT

FIRE/ELECTRICAL DEPARTMENT DATE ENDORSED DATE RELEASED

OFFICE

DATE ENDORSED

DATE RELEASED

ENGINEERING DEPARTMENT/ BUILDING OFFICAL

POLICE DEPARTMENT

DEED OF UNDERTAKING/WAIVER
I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all the requirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirements and in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation of my business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents and purposes. IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

SIGNATURE OF APPLICANT/REPRESENTATIVE POSITION/TITLE

APPROVED BY:

CHIEF - BPLO

SHERWIN T. GATCHALIAN
CITY MAYOR

BPLO COPY

Form VC BPO1
NEW RENEWAL ADDITIONAL QUARTERLY SEMI-ANNUALY ANNUALY

Republic of the Philippines

CITY GOVERNMENT OF VALENZUELA

Metropolitan Manila

DATE MAYORS PERMIT NO.

REQUIREMENTS: NEW BUSINESS: 1. Barangay Clearance 2. Community Tax Certificate (Cedula) 3. Sketch of Business Location All other requirements required by law, ordinance and rules are subject to Pos-Audit process. RENEWAL:
1. 2. 3. Barangay Clearance (2011) Community Tax Certificate (Cedula) 2011 Previous permit and application

BUSINESS TRADE NAME

TEL. NO.

BUSINESS ADDRESS NAME OF TAXPAYER

HOUSE NO. SURNAME

STREET NAME FIRST NAME MIDDLE INITIAL

BARANGAY TEL. NO.

ADDRESS OF TAXPAYERS

HOUSE NO.

STREET NAME

BARANGAY

CITY/MUNICIPALITY

NAME OF PRESIDENT / CEO / MANAGER

SSS NO.:

TIN NO.:

COMMUNITY TAX CERTIFICATE NO.: (INDIVIDUAL OR CORPORATE) IF TRANSFER OF OWNERSHIP FROM WHOM ACQUIRED: CODE LINE OF BUSINESS/ACTIVITIES

DATE ISSUED:

PLACE ISSUED:

GROSS SALES/RECEIPTS

CAPITAL INVESTMENT SUBSCRIBED PAID-UP

TOTAL NO. OF EMPLOYEES/ WORKERS

TOTAL NO. OF EMPLOYEES/ WORKERS FROM VALENZUELA

DELIVERY TRUCKS/VANS/VEHICLES NO. OF UNITS

STORAGE OF FLAMMABLES NO. OF GALLONS: IF PLACE OF BUSINESS IS RENTED / NOT OWNED

ESTIMATED AREA USED IN BUSINESS

NAME OF OWNER: ADDRESS: ADMINISTRATOR: (If name of owner is not available) RENT START: (Month/Year) RENT PER MONTH: TO BE FILLED UP BY NEW APPLICANT ONLY % OF ALIEN CAP INVESTMENT PARTNERSHIP CORPORATION DATE OF ISSUE: DATE OF ISSUE: CERTIFICATE OF OCCUPANCY NO: BOI REG. NO.: DATE OF ISSUE: DATE OF ISSUE:

KIND OF OWNERSHIP SINGLE PROPRIETORSHIP LOCATIONAL CLEARANCE NO.: SEC. REG. NO.:

DTI REG. NO.:

DATE OF ISSUE:

CDA REG. NO.:

DATE OF ISSUE:

TO BE FILLED UP BY PROCESSOR/ASSESSOR ENDORSEMENTS: OFFICE HEALTH DEPARTMENT

FIRE/ELECTRICAL DEPARTMENT DATE ENDORSED DATE RELEASED

OFFICE

DATE ENDORSED

DATE RELEASED

ENGINEERING DEPARTMENT/ BUILDING OFFICAL

POLICE DEPARTMENT

DEED OF UNDERTAKING/WAIVER
I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all the requirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirements and in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation of my business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents and purposes. IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

SIGNATURE OF APPLICANT/REPRESENTATIVE POSITION/TITLE

APPROVED BY:

CHIEF - BPLO

SHERWIN T. GATCHALIAN
CITY MAYOR

TREASURERS COPY

Form VC BPO1
NEW RENEWAL ADDITIONAL QUARTERLY SEMI-ANNUALY ANNUALY

Republic of the Philippines

CITY GOVERNMENT OF VALENZUELA

Metropolitan Manila

DATE MAYORS PERMIT NO.

REQUIREMENTS: NEW BUSINESS: 1. Barangay Clearance 2. Community Tax Certificate (Cedula) 3. Sketch of Business Location All other requirements required by law, ordinance and rules are subject to Pos-Audit process. RENEWAL:
1. 2. 3. Barangay Clearance (2011) Community Tax Certificate (Cedula) 2011 Previous permit and application

BUSINESS TRADE NAME

TEL. NO.

BUSINESS ADDRESS NAME OF TAXPAYER

HOUSE NO. SURNAME

STREET NAME FIRST NAME MIDDLE INITIAL

BARANGAY TEL. NO.

ADDRESS OF TAXPAYERS

HOUSE NO.

STREET NAME

BARANGAY

CITY/MUNICIPALITY

NAME OF PRESIDENT / CEO / MANAGER

SSS NO.:

TIN NO.:

COMMUNITY TAX CERTIFICATE NO.: (INDIVIDUAL OR CORPORATE) IF TRANSFER OF OWNERSHIP FROM WHOM ACQUIRED: CODE LINE OF BUSINESS/ACTIVITIES

DATE ISSUED:

PLACE ISSUED:

GROSS SALES/RECEIPTS

CAPITAL INVESTMENT SUBSCRIBED PAID-UP

TOTAL NO. OF EMPLOYEES/ WORKERS

TOTAL NO. OF EMPLOYEES/ WORKERS FROM VALENZUELA

DELIVERY TRUCKS/VANS/VEHICLES NO. OF UNITS

STORAGE OF FLAMMABLES NO. OF GALLONS: IF PLACE OF BUSINESS IS RENTED / NOT OWNED

ESTIMATED AREA USED IN BUSINESS

NAME OF OWNER: ADDRESS: ADMINISTRATOR: (If name of owner is not available) RENT START: (Month/Year) RENT PER MONTH: TO BE FILLED UP BY NEW APPLICANT ONLY % OF ALIEN CAP INVESTMENT PARTNERSHIP CORPORATION DATE OF ISSUE: DATE OF ISSUE: CERTIFICATE OF OCCUPANCY NO: BOI REG. NO.: DATE OF ISSUE: DATE OF ISSUE:

KIND OF OWNERSHIP SINGLE PROPRIETORSHIP LOCATIONAL CLEARANCE NO.: SEC. REG. NO.:

DTI REG. NO.:

DATE OF ISSUE:

CDA REG. NO.:

DATE OF ISSUE:

TO BE FILLED UP BY PROCESSOR/ASSESSOR ENDORSEMENTS: OFFICE HEALTH DEPARTMENT

FIRE/ELECTRICAL DEPARTMENT DATE ENDORSED DATE RELEASED

OFFICE

DATE ENDORSED

DATE RELEASED

ENGINEERING DEPARTMENT/ BUILDING OFFICAL

POLICE DEPARTMENT

DEED OF UNDERTAKING/WAIVER
I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all the requirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirements and in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation of my business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents and purposes. IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

SIGNATURE OF APPLICANT/REPRESENTATIVE POSITION/TITLE

APPROVED BY:

CHIEF - BPLO

SHERWIN T. GATCHALIAN
CITY MAYOR

ENGINEERINGS COPY

Form VC BPO1
NEW RENEWAL ADDITIONAL QUARTERLY SEMI-ANNUALY ANNUALY

Republic of the Philippines

CITY GOVERNMENT OF VALENZUELA

Metropolitan Manila

DATE MAYORS PERMIT NO.

REQUIREMENTS: NEW BUSINESS: 1. Barangay Clearance 2. Community Tax Certificate (Cedula) 3. Sketch of Business Location All other requirements required by law, ordinance and rules are subject to Pos-Audit process. RENEWAL:
1. 2. 3. Barangay Clearance (2011) Community Tax Certificate (Cedula) 2011 Previous permit and application

BUSINESS TRADE NAME

TEL. NO.

BUSINESS ADDRESS NAME OF TAXPAYER

HOUSE NO. SURNAME

STREET NAME FIRST NAME MIDDLE INITIAL

BARANGAY TEL. NO.

ADDRESS OF TAXPAYERS

HOUSE NO.

STREET NAME

BARANGAY

CITY/MUNICIPALITY

NAME OF PRESIDENT / CEO / MANAGER

SSS NO.:

TIN NO.:

COMMUNITY TAX CERTIFICATE NO.: (INDIVIDUAL OR CORPORATE) IF TRANSFER OF OWNERSHIP FROM WHOM ACQUIRED: CODE LINE OF BUSINESS/ACTIVITIES

DATE ISSUED:

PLACE ISSUED:

GROSS SALES/RECEIPTS

CAPITAL INVESTMENT SUBSCRIBED PAID-UP

TOTAL NO. OF EMPLOYEES/ WORKERS

TOTAL NO. OF EMPLOYEES/ WORKERS FROM VALENZUELA

DELIVERY TRUCKS/VANS/VEHICLES NO. OF UNITS

STORAGE OF FLAMMABLES NO. OF GALLONS: IF PLACE OF BUSINESS IS RENTED / NOT OWNED

ESTIMATED AREA USED IN BUSINESS

NAME OF OWNER: ADDRESS: ADMINISTRATOR: (If name of owner is not available) RENT START: (Month/Year) RENT PER MONTH: TO BE FILLED UP BY NEW APPLICANT ONLY % OF ALIEN CAP INVESTMENT PARTNERSHIP CORPORATION DATE OF ISSUE: DATE OF ISSUE: CERTIFICATE OF OCCUPANCY NO: BOI REG. NO.: DATE OF ISSUE: DATE OF ISSUE:

KIND OF OWNERSHIP SINGLE PROPRIETORSHIP LOCATIONAL CLEARANCE NO.: SEC. REG. NO.:

DTI REG. NO.:

DATE OF ISSUE:

CDA REG. NO.:

DATE OF ISSUE:

TO BE FILLED UP BY PROCESSOR/ASSESSOR ENDORSEMENTS: OFFICE HEALTH DEPARTMENT

FIRE/ELECTRICAL DEPARTMENT DATE ENDORSED DATE RELEASED

OFFICE

DATE ENDORSED

DATE RELEASED

ENGINEERING DEPARTMENT/ BUILDING OFFICAL

POLICE DEPARTMENT

DEED OF UNDERTAKING/WAIVER
I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all the requirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirements and in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation of my business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents and purposes. IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

SIGNATURE OF APPLICANT/REPRESENTATIVE POSITION/TITLE

APPROVED BY:

CHIEF - BPLO

SHERWIN T. GATCHALIAN
CITY MAYOR

HEALTH OFFICE COPY

Form VC BPO1
NEW RENEWAL ADDITIONAL QUARTERLY SEMI-ANNUALY ANNUALY

Republic of the Philippines

CITY GOVERNMENT OF VALENZUELA

Metropolitan Manila

DATE MAYORS PERMIT NO.

REQUIREMENTS: NEW BUSINESS: 1. Barangay Clearance 2. Community Tax Certificate (Cedula) 3. Sketch of Business Location All other requirements required by law, ordinance and rules are subject to Pos-Audit process. RENEWAL:
1. 2. 3. Barangay Clearance (2011) Community Tax Certificate (Cedula) 2011 Previous permit and application

BUSINESS TRADE NAME

TEL. NO.

BUSINESS ADDRESS NAME OF TAXPAYER

HOUSE NO. SURNAME

STREET NAME FIRST NAME MIDDLE INITIAL

BARANGAY TEL. NO.

ADDRESS OF TAXPAYERS

HOUSE NO.

STREET NAME

BARANGAY

CITY/MUNICIPALITY

NAME OF PRESIDENT / CEO / MANAGER

SSS NO.:

TIN NO.:

COMMUNITY TAX CERTIFICATE NO.: (INDIVIDUAL OR CORPORATE) IF TRANSFER OF OWNERSHIP FROM WHOM ACQUIRED: CODE LINE OF BUSINESS/ACTIVITIES

DATE ISSUED:

PLACE ISSUED:

GROSS SALES/RECEIPTS

CAPITAL INVESTMENT SUBSCRIBED PAID-UP

TOTAL NO. OF EMPLOYEES/ WORKERS

TOTAL NO. OF EMPLOYEES/ WORKERS FROM VALENZUELA

DELIVERY TRUCKS/VANS/VEHICLES NO. OF UNITS

STORAGE OF FLAMMABLES NO. OF GALLONS: IF PLACE OF BUSINESS IS RENTED / NOT OWNED

ESTIMATED AREA USED IN BUSINESS

NAME OF OWNER: ADDRESS: ADMINISTRATOR: (If name of owner is not available) RENT START: (Month/Year) RENT PER MONTH: TO BE FILLED UP BY NEW APPLICANT ONLY % OF ALIEN CAP INVESTMENT PARTNERSHIP CORPORATION DATE OF ISSUE: DATE OF ISSUE: CERTIFICATE OF OCCUPANCY NO: BOI REG. NO.: DATE OF ISSUE: DATE OF ISSUE:

KIND OF OWNERSHIP SINGLE PROPRIETORSHIP LOCATIONAL CLEARANCE NO.: SEC. REG. NO.:

DTI REG. NO.:

DATE OF ISSUE:

CDA REG. NO.:

DATE OF ISSUE:

TO BE FILLED UP BY PROCESSOR/ASSESSOR ENDORSEMENTS: OFFICE HEALTH DEPARTMENT

FIRE/ELECTRICAL DEPARTMENT DATE ENDORSED DATE RELEASED

OFFICE

DATE ENDORSED

DATE RELEASED

ENGINEERING DEPARTMENT/ BUILDING OFFICAL

POLICE DEPARTMENT

DEED OF UNDERTAKING/WAIVER
I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all the requirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirements and in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation of my business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents and purposes. IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

SIGNATURE OF APPLICANT/REPRESENTATIVE POSITION/TITLE

APPROVED BY:

CHIEF - BPLO

SHERWIN T. GATCHALIAN
CITY MAYOR

FIRE DEPARTMENT COPY