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1C Application for Fiber Trader-Exporter's License
PhilFIDA renewal 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
(Renewal)
The Administrator
FIDA, Quezon City
Thru :The Fiber Regional Director
Region ___________
Madam :
I have the honor to apply for the renewal of my 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 the approved marks of my establishment are :
_________________
____________________
Initial of Station
Registered Mark
_____________________;
Establishment No.
4.
That my previous license number ________ was issued on ____________ at _____________ and
expired/will expire on ________________________;
5.
That I am exporting ___________ fibers to _______________ (country) and the fibers are baled
and graded by _______________________ (Name/Address of Licensed GBE/Baler);
6.
That I am submitting the following document/s to support my application:
Tax Clearance/Mayor’s
Annual Report of Operation the
Permit
preceding year.
7.
That the following is/are the amendment/s and/or change/s in my original application (if any):
1._______________________________
3. ______________________________
2._______________________________
4. ______________________________
8.
That I shall allow FIDA authorized representative to have free access to my bodega/establishment;
9.
That I shall submit statistical information/data required by FIDA for statistical purposes;
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;
FIDA FORM 1C
2004
11.
Page 2 of 2 pages
That I and my personnel shall at all times comply with the 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.
__________________________________
Signature of Applicant Over Printed Name
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _____
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 with.
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 Trader-Exporter License (Renewal – 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
LICENSE FORM 07
2004
Republic of the Philippines
Department of Agriculture
FIBER INDUSTRY DEVELOPMENT AUTHORITY
Region ____, _______________
Annual Report of Operation
(Trader-Exporter)
Name of Trader-Exporter _________________________________________________________
Address _______________________________________________________________________
Establishment No. ___________________ IS/RM _________________ Class _______________
BALER/GRADER : ________________________________________ (Name of GBE & Marks)
1. Volume of fiber traded the preceding year : A. Inspected ________ B. Loose __________
(No. of Bales)
(No. of kilos)
2. Destination _____________________________________________________ (Country)
3. Volume of fibers exported the preceding year : _______________ ; ___________________
(No. of Bales declared (No. of Bales as verified
by applicants)
thru PTF by Licensing
Officer)
4. Fiber/Origin
Fiber/s
___________________________
___________________________
___________________________
District of Production/Province
_________________________
_________________________
_________________________
______________________________________
Signature of Establishment’s Representative
over Printed Name
Attested by:
_______________________________
Signature of FIDA Representative
over Printed Name
fn: Annual Report of Operation (Renewal Trader-Exporter – October 2004)
