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Application for Certificate of Registration/Permit to operate
PPA application form for permit to operate private ports
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Tracking No. ____________
APPLICATION FOR CERTIFICATE OF REGISTRATION/PERMIT TO OPERATE
APPLICANT PROFILE
Name of Applicant/Company:
Name of Authorized Representative:
Address 1 (Office Address)
Telephone Number 1:
Address 2 (Billing Address):
Telephone Number 1:
E-Mail Address:
Fax Number
Tax Identification Number (TIN)
SEC Registration Number
Business Type:
Single Proprietorship
Partnership
BDT No.
Corporation
Nature of Business:
PRIVATE PORT PROFILE
Port Facility/Structure to be Put-Up:
Draft: ____________________________
Wharf
Date Constructed :
Pier
_________________
Dimensions:
Others
No. & Type : ________________
Utilization:
Location/Site of Private Port:
Barangay _____________________
Foreshore Lease Contract No.
Area size (in sq.m.)
Outstanding Obligation with PPA, if any:
Municipality/City of
TCT No. (Back-Up Area)
Duration/Term of Permit: No. Of Mos. ____
No. Of Yrs. ______
Permit to Construct, O.R. No. (if applicable)
DOCUMENTARY CHECKLIST
VALIDATION FOR PPA USE ONLY
(Put () if submitted, (x) is not available)
Basic Requirements:
_________________________
Filing Fee
Certification Fee
O.R. No.
O.R. No.
Unified Application Form
Date of Payment __________
Date of Payment __________
Duly Notarized Omnibus Undertaking (Sworn Affidavit)
Type of Application:
New
Renewal
Received by:
Printed Name and Signature
Remarks:
Status as of _______________________
Approved
Denied
Pending
