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