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Customer Registration Form
PPA registration form for customer trade account
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: CUSTOMER REGISTRATION FORM
(For TRADE ACCOUNT)
Reminders:
1.
Asterisks (*) mandatory fields, fill-up.
2.
Accomplish one (1) copy per Customer.
3.
Submit accomplished Customer Registration Form to PPA - ICTD (Fax # 02-3019452 )
4.
Attach required supporting documents with this form (BIR form 2303, if Joint Venture – SEC form)
* Action:
[C] Create / [R] Revise / [D] Delete
Customer Code :
(System Generated)
To be filled out by Customer
Customer Details
* Customer Name:
* Short Name:
* DTI Registration Number:
Primary / Principal
Contractor
* Address:
Postal/Zip Code:
* TIN:
Communications
*Contact Name:
*Contact Position:
Fax No. :
*Telephone 1:
E-mail :
Telephone 2:
Prepared by: _____________________________________
____________________________
Date: _____________________
To be filled out by PPA Personnel
*PMO Office :
_________________________________________________
Payment Type:
Customer Group / Profile Class
*Check group that apply
Cargo Handling
Cash
Ancillary Services
Shipping lines
Credit with RF
Choose type of Ancillary Service
Gov’t Office
Bunkering
Laundering
Transport/Trucking
Employee
Cargo Surveying
Lighterage/Bargng
Vessel Maint./Repair
Lessee
Chandling
Parking/Garage
Waste Disposal
Utility User
Cleaning Service
Reproduction Svc
Water Supply
STU
Communication Svc
Security Service
Water Taxi
Others
Container Repair
Shops/Stores
Weighbrge/Truck Scale
Fumigation
Remarks:
Towing/Tugging
Specify:
____________________
Prepared By/Date:
____________________
Authorized by/Date
____________________
Encoded By:
___________________
Checked by/Date
ICTD v2.0 – 02102016
General Instructions
9. Indicate Name of the Person who accomplished the form & affix
signature and date when the form was accomplished.
Indicate the Application type/action by marking the appropriate letter
on the box provided.
Example:
Action:
Example:
Prepared by: Juan De la Cruz______ Date: 01/16/2004_
C
[C] Create / [R] Revise / [D] Delete
For PPA Accounting Use Only
To be filled out by Customer
1. Indicate the Office name and Customer Group with respective
descriptions in the boxes/lines provided.
1. Indicate the Customer Name in the boxes provided.
Example:
PPA Office:
Example: Customer Name:
O
C
L
L
I
M
I
T
E
Ancillary Services
Cargo Handling
Shipping Lines
Gov’t Office
2. Indicate the Customer Short Name in the boxes provided.
O
Example: Short Name:
C
L
2. Indicate the ATC Code (Choices for EWT and CWT are the
following)
3. Indicate the Customer DTI Registration No. in the boxes provided.
Example:
DTI Registration No.:
1
5
5
6
9
9
0
0
2
1
4. Indicate the Customer Address in the boxes provided.
Example: Address:
S
U
P
E
R
P
I
E
R
1
S
O
U
T
H
A
R
E
T
T
E
R
M
I
N
A
H
A
R
B
O
R
,
M
A
N
I
L
L
,
5
A
,
P
O
R
1
0
1
ATC Code EWT
WC100 - 5% - Rentals : Real/personal properties, poles,
Satellites and Transmission facilities, billboards used in
business which the payor or obligator used in business has
not taken or is not taking title or in which has no equity
WC157 - 2% - Payments made by Government Offices on
Local Purchase of Goods and services from Local/resident
suppliers
WC160 - 2% - Income payments made by top 10,000 private
corporations to their local/resident suppliers of services
ATC Code CWT
A
WC120 - 2% - Prime Contractors/sub-contractors
WC157 - 2% - Payments made by Government Offices on
Local Purchase of Goods and services from Local/resident
suppliers
WC160 - 2% - Income payments made by top 10,000 private
corporations to their local/resident suppliers of services
WV020 - 5% - VAT withholding on Purchase of Services
5. Indicate the Customer Address ZIP/Postal Code in the boxes
provided. Check consistency of code w/ address above
Example: Zip/Postal Code
3
6. Country value is pre-supplied.
Example: Country:
Philippines
P H
3. Account Category is pre-supplied with default value to “Cash”.
7. Indicate the Customer TIN in the boxes provided.
Example:
Example: TIN
9 1 2
3 5 7
8 6 0
8 6 0 0
8. Indicate the Customer Contact Person’s Name, Contact Position,
Contact Number/s, Fax No and E-mail Address in the boxes/line
provided.
Example:
Contact Name:
J
U
A
N
Contact Position:
A
G
E
N
PMO-North Harbor
D
D
E
L
A
C
R
U
Z
Cash
4. Payment Term Code value is pre-supplied with default value to
‘Cash”.
Example: Payment Terms: C0000 – Cash
5. Currency Type value is pre-supplied with default value to” Php Peso
Example:
Currency Type:
Philippine Peso
6. Indicate Names and Dates and affix respective signatures of the
persons who provided the information, gave authority to encode,
encoded the information and validated the accuracy.
T
Telephone 1:
0
2
3
0
1
9
2
9
1
Telephone 2:
0
9
1
7
4
3
2
5
5
Fax No.:
0
2
3
0
1
9
2
9
2
6
6
E-mail: _ocl@yahoo.com____________________________________
Example:
ALBorbon
01/19/04
Prepared By/ Date:
RDPineda
01/19/04
Authorized By/ Date:
SBVitales
01/20/4
Encoded By/ Date:
RDMedina
01/21/04
Checked By/ Date:
ICTD v2.0 – 02102016
