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1D Application for Local Trader License

PhilFIDA application form for local trader license

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2004

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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 LOCAL TRADER LICENSE
(Original)

The Administrator
FIDA, Quezon City
Thru : The Regional Director
Region ____________
Madam :
I have the honor to apply for a Trader 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
operating under PD No. 175 and LOI No. 23
corporation;

5.

That I am a

6.

That I am dealing with _________________________________ fiber/s;

7.

That I am submitting the following document/s to support my application :

fiber trader

non-cooperative
single proprietorship

cooperative
partnership

planter-trader who buys the share of my tenants;

Company Profile With Complete
List of Officers
Mayor’s Permit/Tax Clearance

Certificate of Registration from
the SEC
Certificate of Registration from CDA
Certificate of Registration from
BTRCP

8.

That I shall allow FIDA authorized representative to have free access to my establishment;

9.

That I shall submit statistical information/data required by FIDA;

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 1D
2004

11.

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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 _____

________________________
Administrative Officer
(for Class C & D only)

Note: Applications for Class A & B traders must be notarized, while Class C & D must be under
oath to be administered by the Administrative officer.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CERTIFICATION
(To be filled out by the Licensing Personnel)
I hereby certify that the application of _________________________________ for Local Trader
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 total of _____________________ (P ___________)
was paid under OR No. ____________ dated _________.
Remarks: _____________________________________________________________________.

Attested by:
__________________________
Fiber Regional Director

Verified by:
_________________________
Printed Name and Signature

_________________________
Designation

fn: Application for Trade License (Original – October 2004

LICENSE FORM 02
(For Original & Renewal)
2004

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

REPORT ON RE-INSPECTION/RE-EVALUATION OF FACILITIES/PREMISES
(BUYING STATION & LOCAL TRADER (CLASS B, C & D)
1. Name of Establishment/Licensee ________________________________________________
2. Address: ______________________________________ IS/Reg. Mark: _____ Class: _____
3. Location of warehouse: _______________________________________________________
Facilities/Premises/Equipment:
a. With partition to segregate fiber in case other
commodities are stored in the same bodega
b. Clean storage area for fiber with hanging poles/other
similar facilities for drying fiber
c. With concrete flooring storage
d. Weighing Device: (if defective - 0%)
`
TOTAL -

Score

Standard

_____

30%

_____
_____
_____
100%

20%
30%
20%

4. FIDA Signboard : (Complied/Not complied) ______________ ( To be complied within 60 days for
New Licensee
5. Price Bulletin (Complied/Not complied) _________________________________________
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 : __________________
Operator/Manager

Re-inspected/Re-evaluated by : _____________________
Print Name and Signature

_____________________
Designation

Note:
Establishments with total rating below 75% shall not be issued licenses
fn: Report of Inspection (Buying Station, Local Trader, Class B,C,D - October 2004)
 
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