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1D Application for Local Trader License - Renewal
PhilFIDA renewal application form for local trader license
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: FIDA FORM 1A
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 GRADING/BALING ESTABLISHMENT (GBE) 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 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 approved marks of my establishment are :
________ Initial of Station _________ Registered Mark ________ Establishment No.;
4. That my previous license number ____________ was issued on __________ at _________________;
5. That I am exporting ______________(kinds) fiber/s to _____________________________(country);
6. That I am submitting the following documents to support my application:
Report of Operation for the Preceding Year in FIDA form.
List of Fiber Trader/s and Employed Classifier/s in FIDA form.
7. That the following is/are the amendments and/or change/s in my original application/s:
1. ________________________________
3. _______________________________
2. _______________________________
4. _______________________________
8. That I shall allow FIDA representative/s to have free access to my bodega/establishment;
9. That my establishment pressed _____ bales during the preceding year;
10. That I shall provide a segregating partition in case commodities other than fiber are also stored in the
same bodega;
11. That I shall submit statistical information/data required by FIDA;
12. 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 IA
2004
13.
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 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’s 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 05
Revised 2004
Republic of the Philippines
Department of Agriculture
FIBER INDUSTRY DEVELOPMENT AUTHORITY
Region ____,__________
Annual Report of Operation
(Grading/Baling Establishment)
Name of GBE : _________________________________________________________________
Address : _____________________________________________________________________
Establishment No. __________ Initial of Station ________ Reg. Mark ______ Class _____
1.
Dealing with ____________________ fibers.
2.
Origin of Fiber/s:
Fiber/s
___________________________
___________________________
District of Production/Province
_______________________________
_______________________________
3.
Baling Operation :
a.
Volume of fibers baled for own operation _________________________________
b.
Volume of fibers baled for others (State name and address of person/entity)
______________________________
_____________________________________
Name
Address
4.
Inspection of fibers :
a.
Volume of bales inspected : _____________________________________________
( ) For Export _____________ ( ) For Local consumption ________________
(No. of Bales)
(No. of Bales)
b.
( ) Total No. of Bales Pressed ________________ as verified from Primary
Certificates by the Licensing officer.
c.
5.
Volume of approved bales : _____________________________________________
Volume of Sales/Outlets:
( ) For Export _______________
(No. of Bales)
( ) For Local Consumption _________________
(No. of Bales)
6.
Employed _____________________ licensed classifier/s the preceding year.
(number)
7.
Total volume of bales pressed the preceding year
Kind
__________
__________
Volume
___________
___________
Certified Correct:
___________________________
Pres./Prop./Manager
Attested by:
_______________________________
Signature of FIDA Representative
Over Printed Name
fn: GBE Annual Report of Operation (Renewal – October 2004)
