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1C Application for Fiber Trader-Exporter's License
PhilFIDA application form for fiber trader - exporter's license
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: FIDA FORM 1C
2004
Page 1 of 2 pages
Republic of the Philippines
Department of Agriculture
FIBER INDUSTRY DEVELOPMENT AUTHORITY
Quezon City
Control No.
Date Applied
Date Released
License Expires on
: ______
: ______
: ______
: ______
APPLICATION FOR FIBER TRADER-EXPORTER LICENSE
(Original)
The Administrator
FIDA, Quezon City
Thru: The Fiber Regional Director
Region ___________
Madam:
I have the honor to apply for a Trader-Exporter License pursuant to PD 652 in relation to
Executive Order Nos. 709 and 116, and in accordance with the provisions of FIDA Revised
Administrative Order No. 1:
1.
Name of Establishment : ___________________________________________________________
Address : _________________________________ Tel. No._____ Fax No. ______ E-mail ______
Metro. Mla. (if any) ________________________ Tel. No.______ Fax No. ______ E-mail ______;
2.
That I, _________________________________________________, _____________ (Nationality)
residing at ________________________________________________ with TIN: ______________
represent the above establishment as ___________________________________(Pres./Mgr./Prop.);
3.
That I intend to use _________________ as my registered mark;
4.
That the form of my business organization is
single proprietorship
partnership
corporation
cooperative operating under PD No. 175 and LOI No. 23;
5.
That my fibers will be baled and graded by ____________________________________________
_____________ (Name/Address of Licensed GBE /Baler);
6.
That I intend to export _______________ fiber/s to ______________________ (country);
7
That I am submitting the following document/s to support my application : (Please check
appropriate box)
Company Profile with Complete List
of Officers
SEC Certification
CDA Certification
Tax Clearance/Mayor’s Permit
BTRCP Certification
8.
That I shall allow FIDA authorized representative to have free access to my establishment ;
9.
That I shall submit monthly statistical information/data required by FIDA for monitoring purposes;
FIDA FORM 1C
2004
Page 2 of 2 pages
10.
That I have ____(number) employee/s of whom ____ (number) is/are male/s and _____ (number)
is/are female/s with an average of _____ (number) dependent/s per employee;
11.
That I and my personnel shall at all times comply with FIDA rules and regulations.
I hereby certify under the penalty of law to the veracity of the above statements and that this
application was prepared by me or my authorized representative under my personal direction.
________________________________
Printed Name and Signature of Applicant
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________________ ) S.S.
Municipality of _________________)
SUBSCRIBED AND SWORN to before me on this ______ day of _________ 200___ affiant
exhibiting to me his/her Community Tax Certificate No. ___________ issued at _______________ on
_____________ 200____.
Notary Public
Until December 200 __
Doc. No. _____
Book No. _____
Page No. _____
Series of _____
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ______
CERTIFICATION
(To be filled out by the Licensing Personnel)
I hereby certify that the application of _______________________________ for Trader-Exporter
License has been reviewed/verified by me and that all requirements are duly complied.
Application fee of ______________________________________ (P _________ ) and license fee
of ____________________ (P _________ ) for a total of ________________________ (P __________ )
was paid under OR No. ___________________ dated _____________.
Remarks: __________________________________________________________________.
Attested by:
Verified by:
___________________________
Fiber Regional Director
__________________________
Printed Name and Signature
__________________________
Designation
fn: Application for Fiber Trader-Exporter’s License (Original – October 2004)
LICENSE FORM 01
Revised 2005
Republic of the Philippines
Department of Agriculture
FIBER INDUSTRY DEVELOPMENT AUTHORITY
Quezon City
Region ________
_______________
Date of Inspection
REPORT ON INSPECTION/EVALUATION OF FACILITIES/PREMISES
(FOR GBE, CLASS A TRADER & TRADER-EXPORTER ONLY)
1. Name of Establishment ______________________________________________________
2. Address: _________________________IS/Reg. Mark: ______________ Class: ________
3. Location of warehouse/premises & facilities: _____________________________________
Facilities/Premises:
Rating
Standard Rating
a. With partition to segregate fiber in case other
commodities are stored in the same bodega
______
b. With clean storage and adequate classification area ______
c. With adequate lighting facilities
______
d. With hanging poles/other similar facilities for drying ______
e. With restriction signs, such as “no smoking”’
“no plastic allowed”, etc.
______
f. Weighing Device: (if defective – 0%)
______
30%
20%
20%
10%
10%
10%
100%
4. Number of licensed classifiers employed by the applicant: _______________;
5. Floor area of warehouse: ________ sq. m.; adequate
6
Kind of pressing machine:
7. With cloth tag
ordinary
9.FIDA Signboard : Complied
10. Price Bulletin : Complied
(Pls. check)
high density ;
without cloth tag
8. With locker
without locker
employee assigned thereat;
; inadequate
;
for government stamps & other facilities for FIDA
; Not Complied
Not complied
; New licensee
(To be complied
within 60 days)
;
I/We hereby certify that the foregoing inspection report was based on the actual
inspection conducted by undersigned FIDA representative on the facilities/premises of the
above establishment/licensee.
Remarks/Recommendations: __________________________________________________________
Conforme: _______________________ Re-inspected/Re-evaluated by : _______________________
Operator/Manager
Print Name and Signature
______________________
Designation
Note:
Establishments with rating below 75% in facilities/premises shall not be issued licenses
fn: Re-inspection/Re-evaluation of GBE, Class A Trader, Trader Exporter only, 2005
