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1E Application for Processor's License

PhilFIDA application form for processor's 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 PROCESSOR LICENSE
(Original)

The Administrator
FIDA, Quezon City
Thru: The Fiber Regional Director
Region ________________
Madam:
I have the honor to apply a Processor 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
sole proprietorship
partnership
cooperative operating under PD No. 175 and LOI No. 23;

4.

That I intend to use ____________________ as my registered mark;

corporation

Certification of Registration from CDA
5.

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

6.

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

7.

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.

8.

That I am a processor/manufacturer of
mattress
fibercraft

9.

That I will be using ______________ fiber/s from _______________ (Country/Province of Origin);

10.

That I am submitting the following document/s to support my application :
Company Profile With Complete
List of Officers
Mayor’s Permit/Tax Clearance

rope/twine
pulp/paper
others, specify _________________;

textile

Certificate of Registration from SEC
Certification of Registration from
BTRCP

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FIDA FORM 1E
2004

11.

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 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 Processor 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 Processor’s License (Original – October 2005)

LICENSE FORM 03
(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
(PROCESSOR/MANUFACTURER)

1. Name of Establishment/Licensee ______________________________________________
2. Address : ___________________________________ IS/Reg. Mark _______ Class ______
3. Location of warehouse : ______________________________________________________
Facilities/Premises/Equipment:

Score
a. With partition to segregate fiber in case other
commodities are stored in the same bodega
b. Clean storage, classification and working
processing area for fiber with sufficient ventilation
and lighting facilities on fiber classification
c. With restriction signs such as “no smoking’,
“no plastic allowed”, etc.
d. Weighing Device: (if defective – 0%)
TOTAL -

Standard

____

30%

_____

30%

_____
_____

25%
15%
100%

4. FIDA Signboard : (Complied/Not complied) ____________ (To be complied within 60 days,
for New Licensee)
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 total rating below 75% shall not be issued licenses

fn: Report of Re-inspection/Re-evaluation (Processor – Mfrer- original-renewal 2004)
 
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