TC Form 5

INFORMATION FOR THE CONDUCT OF

INVESTIGATION PURSUANT TO THE
SAFEGUARD MEASURES ACT (RA 8800)

For TC use only

TCI (SG) No.: ____________

Date : __________________
Records Officer : __________

(To be submitted in triplicate)

I. GENERAL INFORMATION
Please check one:
Petition by Domestic Industry for Extension of Measure
TC Monitoring of Developments in Domestic Industry
TC Evaluation of Effectiveness of Action Taken by the Domestic Industry
A. Petitioner/Domestic Manufacturer
1. Name of Company: ___________________________________
2. Name of President: ___________________________________
3. Contact Details:
a.

Office
Contact Person:
Position :
Tel./Fax Nos.:
Email Address:
Address:

b.

_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

Plant/Factory
Contact Person:
Position :
Tel./Fax Nos.:
Email Address:
Address:

_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

4.

SEC Registration No.:

Date Registered:

_______________________________
_______________________________

5.

BOI Registration No.:

Date Registered:

_______________________________
_______________________________

6.

ISO Certification (type and no.): _________________________

Date Registered:
_______________________________

Page 1 of 6

TC Form 5| Revised August 2016

II. PRODUCT INFORMATION

A. Article(s) Produced Subject of Safeguard Action
Product(s)

AHTN Code

Rate of Duty (%)

III. RELEVANT ECONOMIC AND FINANCIAL DATA

Please supply data for each product covering the last three (3) years up to the most recent period
for which data are available. Use separate sheet if necessary.
A. Market Share (%)
Year

Q1

Q2

Q3

Q4

Total

B. Rated Capacity, Actual Production and Capacity Utilization

Year

Annual Rated Capacity

(Volume)
(unit of measure)

Actual Production
Volume
Value
(unit of measure)
(PhP)

Capacity
Utilization
(%)

C. Domestic and Export Sales

Year

Domestic
Volume
Value
(unit of measure)
(PhP)

Volume
(unit of measure)

Export
Value
(PhP)

Country of
Destination

Submit a separate sales report on your importation of subject article/s, if any,

Submit a separate sales report on your importation of subject article/s, if any, for re-export.

Page 2 of 6

TC Form 5| Revised August 2016

D. Inventory
1. Finished Goods
Beginning Inventory
Volume
Value
(unit of measure)
(PhP)

Year

Ending Inventory
Volume
Value
(unit of measure)
(PhP)

2. Major Raw Materials

Year

Raw
Material

Source
(Local
and/or
Imported)

Beginning
Inventory
Volume
Value
(unit of
(PhP)
measure)

Consumed
Volume
(unit of
measure)

Value
(PhP)

Ending
Inventory
Volume
Value
(unit of
(PhP)
measure)

(1)
(2)
(3)

E. Selling Prices
Year

Domestic Selling Price

(PhP / unit of measure)

Price of Imported Counterpart

(PhP / unit of measure)

Please submit information on distributors discounts / commission or any other data that affect the selling price
of the subject article.

F. Employment and Compensation Data

Year

Employment (Number)
Directly involved in
Total
production

Compensation (PhP)
Directly involved in
Total
production

G. Audited Financial Statements (For the last three (3) years)

Please submit copies of audited financial statements including Notes to Financial Statements.
Submit also statements/schedules on cost of goods sold, depreciation/amortization; and long-term
liabilities.
If the company has multiple products, please prepare separate statements of income as well as
separate schedules specific to the subject article.

Page 3 of 6

TC Form 5| Revised August 2016

H. Cost of Production (For the last three (3) years)

Please present separate costs for each product type. Use separate sheet if necessary.
Particulars
Product
Production Volume

Type

Year 1
Type
Average

Type

Year 2
Type

Average

Type

Year 3
Type Average

Unit Cost of Production

(Peso/Unit)
Materials and Supplies:
(1)
(2)
(3)
Total Raw Materials
Direct Labor
Manufacturing Overhead:
Indirect Labor
Fuels:
Gasoline
Diesel
Bunker
Others 1/
Electricity
Water
Packaging
Depreciation
Rent
Others 1/
Total Manufacturing
Overhead
Total Unit Cost of
Production
Operating Expense 2/
Cost to Produce & Sell
1/
2/

- Identify costs separately.

- Identify each expense/cost separately. Separate handling and delivery expenses.

Page 4 of 6

TC Form 5| Revised August 2016

IV. COMPLIANCE WITH ADJUSTMENT PLAN

A. In Adjustment Plan
Please list ALL the measures specified in your adjustment plan. If a measure was not
implemented, please provide an explanation. Moreover, please provide documentation to prove
that the specific measures were undertaken, the percentage of completion, and the positive effects
that were achieved.
Specific
Measures
Undertaken

Period of
Implementation

Percentage of
Completion

Expenditure
(Php)

Positive
Effects

Remarks

B. New Measures
Please list additional measures that you undertook/intend to undertake as part of your adjustment
plan to import competition. For the specific measures that were undertaken, please provide
documentation to prove that the specific measures were undertaken, the percentage of completion,
and the positive effects that were achieved.
Specific
Measures
Undertaken

Period of
Implementation

Percentage of
Completion

Expenditure
(Php)

Positive
Effects

Remarks

V. CERTIFICATION
I hereby certify that all information contained herein is true and correct and relate to the
subject article(s). I commit that any additional information required will be submitted within 10
working days after receipt of request from the Commission.

_________________________________
Petitioners Signature over Printed Name

Page 5 of 6

TC Form 5| Revised August 2016

GENERAL INFORMATION AND INSTRUCTIONS

A.

Steps in the Application for Extension of Measure Pursuant to Section 712 of the Customs
Modernization and Tariff Act (CMTA):
Step
1

Activities 1
Proceed to Cashier for payment of
investigation fee 2

Unit/
Person-In-Charge
Cashier

Fees
P20,000.00
(Filing Fee)
P200.00
(Legal Research Fund Fee)

Preliminary Conference 3

Presiding Officer

Submission of initial memoranda /

position paper 4
Ocular inspection of plant facilities /
Verification of data 5
Public Hearing 6

Records Officer

4
5
6
7

Task Force
Petitioner to pay
publication cost 7

Submission of amended position

paper / principal memoranda 8
Issuance of TC Report of Findings and
Recommendations to Secretary of
Agriculture/Trade and Industry and
Parties 9

Presiding Officer
Records Officer
Task Force /
Records Officer /
Planning
Management and
Information
Systems Division

Investigative Timetable: 120 calendar days from receipt of the referral of the Secretary /
60 calendar days if certified urgent by the Secretary
2 Parties will be informed of initiation of TC formal investigation; Processing time: 30 minutes
3 Parties will be informed of schedule of preliminary conference
4 Parties will be informed of deadline for submission of position papers
5 Parties will be informed of schedule of ocular inspection/data verification
6 Parties will be informed of schedule of public hearing
7 Notice of billing will be sent to parties
8 Parties will be informed of deadline for submission of documents
9 Check status of investigation on TC website: www.tariffcommission.gov.ph

B.

Required attachments upon submission of TC Form 5:

1. Audited Financial Statements
2. Statements of Income specific to subject article
3. Schedule on Cost of Goods Sold, Depreciation/Amortization, and Long-Term Liabilities

C.

Information deemed confidential should be so marked.

D.

Notes:
The Tariff Commission reserves the right to request additional information deemed
necessary in the review.
Information submitted is subject to verification.
For any clarification, please call the Office of the Director, Research, Investigation
and International Trade Analysis Service (RIITAS) at telephone numbers: 433-58-98/
926-74-76.

Page 6 of 6

TC Form 5| Revised August 2016