Revised PNP FORM 6-B4

As of April 2016

APPLICATION FOR SPECIAL PERMIT TO PURCHASE AND MOVE CONTROLLED CHEMICALS

Manufacturer
Dealer
Purchaser

DATE
CHIEF, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

Company Name:
Office Address:
Storage Facility/Warehouse Address:
Nature/Line of Business:
License No:
Purpose/use of controlled chemicals:

Request for authority to purchase and move the following controlled chemicals:

KIND QUANTITY APPLIED FOR REMARKS

Indicate storage capacity versus

production capacity for one (1) year

If this request is approved, I do hereby covenant and agree that I will safely keep and lawfully
dispose the above-described controlled chemicals and will faithfully comply with all laws, rules and
regulations which are now or hereafter maybe enforced.

Printed Name and Signature of Applicant

 FEO PROCESSING

QTY BALANCE AS QTY TOTAL STOCK ON

AUTHORIZED OF__________ RECOMMENDED HAND (INCL QTY
KIND ACQUISITION DISPOSITION
IN THE (DATE) BY FEO APPLIED FOR)
LICENSE

RECOMMEND:

APPROVAL

DISAPPROVAL

Chief, Explosives Management Division

APPROVED

DISAPPROVED

Chief, Firearms and Explosives Office