CDRRHR’s Copy Cashier’s Copy

QWP-CDRRHR/LRD-07 Annex 01
QWP-CDRRHR/LRD-07 Annex 01 Rev. 01 Date Effective: 18 October 2017
Rev. 01 Date Effective: 18 October 2017

DATE: ____________________ DTN: DATE: ____________________ DTN:_______________

Applicant Company: _______________________________________________________ Applicant Company: _______________________________________________________
Address/Email/Tel No.___________________________________________________________ Address/Email/Tel No.___________________________________________________________
Promo Title: _______________________________________________________________________ Promo Title: _______________________________________________________________________
. . . .

Permit No.: Permit No.:

COVERAGE Home Solicitation Sales Promotion COVERAGE Home Solicitation Sales Promotion
Sale Sale
NATIONAL CAPITAL REGION only or in several PhP 760.00 PhP 1,010.00 NATIONAL CAPITAL REGION only or in several PhP 760.00 PhP 1,010.00
regions including NCR and NATIONWIDE regions including NCR and NATIONWIDE
More than (1) region but excluding NCR 760.00 760.00 More than (1) region but excluding NCR 760.00 760.00
Several provinces/cities/municipalities within a 560.00 560.00 Several provinces/cities/municipalities within a 560.00 560.00
single region single region
Single province / city /municipality 260.00 260.00 Single province / city /municipality 260.00 260.00

Amount of fees for sales promotions (except for discount scheme type of promotion shall be in Amount of fees for sales promotions (except for discount scheme type of promotion shall be in
accordance with the schedule enumerated hereunder or in accordance with geographical areas, accordance with the schedule enumerated hereunder or in accordance with geographical areas,
whichever is higher) whichever is higher
Amount of Prizes Fee Amount of Prizes Fee
PhP 50,000.00 PhP 260.00 PhP 50,000.00 PhP 260.00
50,001.00 – 150,000.00 510.00 50,001.00 – 150,000.00 510.00
150,001.00 – 300,000.00 1,010.00 150,001.00 – 300,000.00 1,010.00
300,001.00 – 500,000.00 2,020.00 300,001.00 – 500,000.00 2,020.00
500,001.00 – 1,000,000.00 3,030.00 500,001.00 – 1,000,000.00 3,030.00
Above 1,000,000.00 5,050.00 Above 1,000,000.00 5,050.00

Amendment/Extension 310.00 Amendment/Extension 310.00

_______________________________________
PAYMENT DETAILS PAYMENT DETAILS
EVALUATOR CASHIER EVALUATOR CASHIER
Fee : ________________________ Amount : ___________________________ Fee : ________________________ Amount : ___________________________
Legal Research Fee (1%):_______________ Legal Research Fee (1%):_______________
Surcharge : ________________________ OR Number : ___________________________ Surcharge : ________________________ OR Number : ___________________________
TOTAL : ________________________ Date Issued : ___________________________ TOTAL : ________________________ Date Issued : ___________________________
Evaluated by : ________________________ Received by : ___________________________ Evaluated by : ________________________ Received by : ___________________________
RECEIPT DETAILS RECEIPT DETAILS
Name : ________________________________________ Name : ________________________________________
Signature : ________________________________________ Signature : ________________________________________

(DTI-DOH-A.O. No. 1 s. 2000) (DTI-DOH-A.O. No. 1 s. 2000)