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BWC-IP3-rev_2011 Application for Registration / Re-registration
BWC application form for OSH registration/re -registration
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Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No.
Registry of Establishment
EIN:
1. Name of Establishment
2. Address
Street
City/Municipality
3. TIN :
4. Telephone No. :
Fax No. :
Email Address:
5. Name of Manager / Owner
6. Nature of Business & Product Manufactured, Service rendered or Merchandise sold:
Province
( Example Manufacturing -- Textile, Construction -- Building, Agriculture -- Production of Livestock, etc; Forestry Logging; Services -- Generation and Distribution of Electricity, Commerce - Lumber and Construction Materials;
Wholesale or Retail)
7. Number of Employees
Total
Filipinos
Resident
Alien
NonResident
Alien
Below 15
Below 15Above 30
18-30 yrs
17 yrs
yrs.
Male
Female
Grand Total
8. Name & Address of Labor Union, if any:
BLR Registration No.
9. Technical Information (Please Check / Enumerate)
9a. Machinery, Equipment and Other Devices in use:
Circular saw
Machine Drill Press
Boiler
Pressure Vessel
Internal Combustion Engine
Engine Diesel
Gasoline
Others, Specify
9b. Materials Handling Equipment:
Power Trucks
Hand Trucks
Conveyors
Forklift
Cranes
Others, Specify
9c. Chemical or Substances Used or Handled:
10.If Branch unit, name of parent establishment:
Location
11.Current Capitalization
Total Assets:
12.Photocopy of DTI Certificate of Registration / Business Permit (pls. attach)
FOR RE-REGISTRATION ACCOMPLISH ALSO:
13.Past Application Number
14.If Changing Name of Establishment, State Former Name;
15.If Changing Location, Give Past Address:
Date of Application
I hereby certify that the above information is true and correct.
Owner/President
Date Filed :
Date Approved:
Approved by:
(Regional Director or Assistant Regional
Director or Head of Field Office)
