REPUBLIC OF THE PHILIPPINES

PROVINCE OF CAVITE
MUNICIPALITY OF BACOOR

BUSINESS PERMITS AND LICENSING OFFICE

_____________________________ _____________________
CITY/MUNICIPALITY DATE OF APPLICATION

SURNAME FIRST NAME M.I. TEL. NO.

NAME OF TAXPAYER

COMPLETE ADDRESS OF TAXPAYER

BUSINESS TRADE NAME

TEL. NO.
COMPLETE ADDRESS OF BUSINESS

BUILDING PERMIT NO. (IF BLDG. IS OWNED DATE ISSUED CERTIFICATE OF OCCUPANCY DATE ISSUED

ASSESSED VALUE OF BLDG. IF USED AS THEATER, INDICATE CLASS ESTIMATE AREA USED IN BUSINESS

IF PLACE OF BUSINESS IS RENTED

OWNER ADDRESS ADMINISTRATOR RENT START RENT PER MO.

(IF OWNED NOT AVAILABLE) (MO. / YR.)

CITY/MUNICIPAL TAXES PAID FOR THE PREVIOUS YEAR IN CASE OF TRANSFER

YEAR COVERED TOTAL AMOUNT PAID DATE OF LAST PAYMENTS LAST OFFICIAL RECIEPT NO.

IF TRANSFER OF OWNERSHIP BUSINESS PERMIT NO.

FROM WHOM ACQUIRED

IF TRANSFER OF BUSINESS, FROM WHERE

ADDRESS

LINE OF BUSINESS/ACTIVITIES SUBSCRIBED CAPITAL PAID-UP CAPITAL CODE

KIND OF OWNERSHIP % ALIEN CAP INVESTMENT TIN

SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION

(RESIDENCE CERTIFICATE NO. DATE OF ISSUE PLACE OF ISSUE

INDIVIDUAL OR CORPORATE

SSS NO. NO. OF EMPLOYEES

BUREAU OF COMMERCE REG. NO. DATE OF ISSUE SEC. REG. NO. DATE OF ISSUE

LOCATIONAL CLEARANCE DATE OF ISSUE SEC. REG. NO. DATE OF ISSUE

DELIVERY VANS/ (a) AS DEALER/PRODUCER OF DISTILLED SPIRITS, SOFTDRINKS, CIGARETTES, ETC NO. OF UNITS
TRUCKS OWNED (b) AS DEALER/PRODUCER OF OTHER PRODUCTS NO. OF UNITS

________________________________________ __________________________________________
(PRINT NAME OF MANAGER) SIGNATURE OF APPLICANT/REPRESENTATIVE

__________________________________________
POSITION / TITLE

SUBSCRIBED AND SWORN TO BEFORE ME THIS ____________________________ DAY OF ______________, ___________ AT

THE CITY/MUNICIPALITY OF ___________________________ AFFIANT EXHIBITED TO ME HIS/HER RESIDENCE CERTIFICATE
NO. A. ______________________________ ISSUED AT ______________________ ON __________________________________

DOC. NO. __________

PAGE NO. _________
BOOK NO. _________ _________________________________________
SERIES OF _________ ADMINISTERING OFFICER
 TO BE FILLED BY THE PROCESSOR/ ASSESSOR

ENDORSEMENTS
DATE ENDORSEMENT
OFFICE RECEIVED DATE RELEASED REMARKS (AUTHORIZED OFFICIAL)
HEALTH DEPARTMENT
FIRE/ELECTRICAL DEPARTMENT
ENGINEERING DEPT/
BUILDING OFFICIALS
ZONING

ASSESSMENTS
CITY/MUNICIPAL TAXES, FEES & CHARGES TO BE PAID FOR THE CURRENT LICENSE PERIOD

MODE OF PAYMENT ANNUALY BI-ANNUALY QUARTERLY

LOCAL TAXES REFERENCES AMOUNT PENALTY TOTAL ASSESSED BY

(SUBCHARGE & INT.)
SEC 15-19
LOCAL BUSINESS 37 & 44 RCMM
TAX ON DELIVERY VANS/TRUCKS SEC 34, RCMM
TAX ON STORAGE FOR COMBUSTIBLE/ SEC. 19(25)
FLAMMABLE OR EXPLOSIVE SUBSTANCE RCMM
TAX ON SIGNBOARD/BILLBOARDS SEC. 40 RCMM

REGULATORY FEES/CHARGES
MAYOR’S PERMIT FEE SEC 105 RCMM
GARBAGE CHARGES SEC. 63 RCMM
SEC105(b)
DELIVERY VANS/TRUCK PERMIT FEE RCMM
SANITARY INSPECTION FEE SEC.109, RCMM
BUILDING INSPECTION FEE P.D. 1096
ELECTRICAL INSPECTION FEE P.D. 1096
MECHANICAL INSPECTION FEE P.D. 1096
PLUMBING INSPECTION FEE PD. 1096
SIGNBOARD/BILLBOARDS P.D. 1096
RENEWAL FEE
SIGNBOARD/BILLBOARDS SEC. 105 (b)
PERMIT FEE 13, RCMM
STORAGE AND SALE OF COMBUSTIBLE SEC. 105 (b)
FLAMMABLE OR EXPLOSIVE SUBSTANCE 11, RCMM
ZONING

· REFER TO DS FOR INSPECTION/ASSESSMENT P____________ P _____________ P ____________

_ ___________________ _____________________ ___________________

RECOMMENDING APPROVAL
ASSESSMENTS REVIEWED BY:

_________________________________ _________________________________
LICENSE DIVISION Chief - BPLO

APPROVED BY: HON. STRIKE B. REVILLA

MUNICIPAL MAYOR

___________________________________________
DATE ISSUED

OR. NO. ____________________

PERMIT NO. ________________

INSTRUCTIONS:

1. DO NOT FILL UP SHADE BLOCKS, THESE ARE FOR CODING PURPOSE

2. FILL UP ALL THE UNSHADED BLOCKS IN THE FRONT PAGE, PRINT LEGIBLY, CORRECTLY AND COMPLETELY
OTHERWISE IT SHALL BE RETURNED FOR PROPER ACCOMLISHMENTS.
3. FOR LINE OF BUSINESS:
a) INDICATE ALL BUSINESS ACTIVITIES USE A SEPARATE SHEET; IF NECESSARY
b) INDICATE CAPITAL INVESTMENTS ( FOR CORPORATION, BOTH ITS PAID-UP AND SUBSCRIBED ) FOR EACH (LINE BUSINESS)
4. THIS FORMS SHALL BE SUPPORTED BY:
a) ZONING OR LOCATIONAL CLEARANCE.
b) OTHER CLEARANCES OR PERMITS FROM VARIOUS OFFICES OR AGENCIES, DEPENDING ON THE FUTURE OF BUSINESS.
c) ARTICLE OF INCORPORATION AND REGULATION WITH THE SEC FOR PARTNERSHIP OR CORPORATION.
d) TAX EXEMPTION CERTIFICATE IF BUSINESS IS CLAIMING TAX EXEMPTION.
e) DECLARATION SHEETS.