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1A Application for GBE's License

PhilFIDA application form for grading/balling establishment license

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2005

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Republic of the Philippines
Department of Agriculture
FIBER INDUSTRY DEVELOPMENT AUTHORITY
Quezon City

Control No.
:
Date Applied
:
Date Released
:
License Expires on :

_________
_________
_________
_________

APPLICATION FOR GRADING/BALING ESTABLISHMENT (GBE) LICENSE
(Original)

The Administrator
FIDA, Quezon City
Thru: The Fiber Regional Director
Region ________
Madam:
I have the honor to apply for a Grading/Baling Establishment (GBE) 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 form of my business is a (Pls. check) :
sole proprietorship
partnership
corporation
cooperative operating under PD 175 and LOI No. 23;
4. That I intend to use _________________________ as my registered mark;
5. That I will be exporting ____________________ (kinds) fiber/s to __________________ (country);
6. That I have ___________ (number) employed licensed classifier (s);
7. That I am submitting the following document/s to support my application:
Company Profile with Complete List of Officers

Certificate of Registration from SEC
(for corporation/partnership)

Tax Clearance/Mayor’s Permit
Certificate of Registration by the Cooperative
Development Authority (CDA), for Cooperative.

Certificate of Registration from BTRCP
(for sole proprietorship)

8. That I am submitting together with this application the list of my suppliers and Report of Operation
for the preceding year;
9. That I shall allow FIDA authorized representative to have free access to my establishment;
10. That I shall not allow any other person to operate and/or use the grading/baling establishment and its
facilities without written authority from the Administrator;
11. That I shall submit statistical information/data as required by FIDA for fiber monitoring purposes
only;

FIDA FORM 1A
2005
12

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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;

13. That I and my personnel shall at all times comply with the requirements pursuant to the provisions
of FIDA Revised Administrative Order No. 1.
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 Licensing Personnel)

I hereby certify that the application of ____________________________________________for
Grading/Baling Establishment (GBE) license has been reviewed/verified by me and that all the
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 GBE License (Original – February 2005)

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
 
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