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Well Drillers Annual Registration Form

NWRB registration form for well drillers

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: NATIONAL WATER RESOURCES BOARD
8th Floor, N.l.A. Building, E.D.S.A., Quezon City

OWNER./PRESIDENT

Tel./Fax No. 920-2654

2x2
picture

MONITORING & ENFORCEMENT DIVISION
ControlNo.

WELL DRILLER'S ANNUAL REGISTRATION FORM
.

TIN:

REGISTERED NAME
BUSINESS/OFFICE ADDRESS:

Tel. No.:

Fax No.:

E-mail Address:

EQUIPMENT YARD

Tel. No.

OWNER/PBESIDENT

T.I.N:

HOME ADDRESS:

7.

Tel.

No.:

Mobile No.:

CATEGORY:
.

lndividual/ Single

TYPE OF REGISTRATION

MechanizedDrilling

Proprietorship

t1

E-mailAdd.:
ManualDrilling

II

Partnership / Corporation / Cooperative

:

New

tl
11

No.:

WELL DRILLER CLASSIFICATION:

tI
10

[]

Fax

tl

Renewal

IF RENEWAL:
Date lssued

Registration No.:

:

I hereby declare that all the foregoing answers, informations, statements
documents are complete, true and correct.

a

Com. Tax Cert. No.:
lssued at:
DATE

lssued on:

ORDER OF PAYMENT
Wett

Ditler Annual Registration Fee Effective November

P 2,500.00 (lndividual /

Single)

11

, 2015

Total

Amount:

P

P 5,000.00 (Partnership / Corporation)

(Anears)

En6iffi;nlSffin

(TO BE FTLLED UP BYTHE CASHTER)

Official Receipt No.:
Date lssued::

Cashier Section
REruRN TH4S FORMTO THEHONITORII{rG &E lFtORCEreNr t,fViSf()fl FORRECORD PURPIOSES'

NATIONAL WATER RESOURCES BOARD
8th Floor NIA Building, EDSA, Quezon City
Tel./Fax No. (02) 920-26-54
MONITORING & ENFORCEMENT DIVISION

REQUIREMENTS FOR ANNUAL WELL DRILLER’S REGISTRATION
A. INDIVIDUAL / SOLE PROPRIETORSHIP
1.
2.

3.
4.
5.
6.
7.

8.
9.

Duly accomplished well driller’s annual registration form with one (1) pc. 2 x 2 picture
Name/s of personnel with three (3) years experience in mechanized well drilling work as certified by duly registered
mechanized well driller; or holder of a bachelor's degree in geology, civil, mechanical, or other related engineering
courses with one (1) year experience in actual drilling work.
Certificate of Registration of Business Name issued by the Department of Trade and Industry (DTI)
Contractor’s License issued by the Philippine Contractor’s Accreditation Board (PCAB), if available.
Audited Financial Statement
List of Drilling and other Equipment
List of Completed and On-going Projects, indicating the following:
Name of Project
Exact location of Project (No., Street, Sitio, Brgy., City/Municipality, Province)
Owner
Year Completed
Office Address
Contact Person
Telephone No.
Photo copy of latest Certificate of Well Driller’s Registration, if renewal
Annual Registration Fee of P 2,500.00

B. PARTNERSHIP / CORPORATIONS
1.
2.

3.
4.
5.
6.
7.

8.
9.

Duly accomplished well driller’s annual registration form with one (1) pc. 2 x 2 picture
Name/s of personnel with three (3) years experience in mechanized well drilling work as certified by duly registered
mechanized well driller; or holder of a bachelor's degree in geology, civil, mechanical, or other related engineering
courses with one (1) year experience in actual drilling work.
Certificate of Registration from Security and Exchange Commission (SEC)
Contractor’s License issued by the Philippine Contractor’s Accreditation Board (PCAB), if available.
Audited Financial Statement
List of Drilling and other Equipment
List of Completed and On-going Projects, indicating the following:
Name of Project
Exact location of Project (No., Street, Sitio, Brgy., City/Municipality, Province)
Owner
Year Completed
Office Address
Contact Person
Telephone No.
Photo copy of latest Certificate of Well Driller’s Registration, if renewal
Annual Registration Fee of P 5,000.00

NOTE:
•
For Manual Well Drillers
1. Three (3) years experience in manual well drilling a certified by a duly registered well driller
2. Certificate of Registration of Business Name issued by DTI or business permit issued by the local
government unit
3. Annual Registration Fee:
A. Individual/Sole Proprietorship
P 2,500.00
B. Partnership/Corporation
P 5,000.00

•

All submitted documents for well driller’s registration must be in company
letterhead duly certified by the owner/president and fastened in a long folder.

Enforcement Section: November 2015
 
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