Philippine Government Forms All in One Location
SD-SCD-QF15 Application for Extension/ Reduction in of Scope in Certification
DTI BPS application/ reduction form for extension and reduction of scope in certification
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01 May 2016
1 of 1
BPS PRODUCT CERTIFICATION SCHEME
Application for Extension / Reduction in the Scope of
The Bureau Director
Bureau of Philippine Standards
Department of Trade and Industry
3/F, Trade and Industry Building
361 Sen. Gil J. Puyat Avenue
In accordance with Department Administrative Order No.4:2008 and its future amendments, promulgated pursuant to Section 79 (B) of
the Revised Administrative Code of the Philippines and Executive Order No. 101, Series of 1967, in conjunction with the provisions of R.A. 4109
and R.A. 7394, we hereby apply for extension/reduction in the scope of the Philippine Standard (PS) Quality and/or Safety Certification Mark.
Company’s Registered Name
Complete Plant Address
PS License Number
President/ General Manager
Quality Management Representative
Deputy Quality Management Rep.
Specific model/type/sizes applied for :
(For DTI use only)
In the event the application is granted, we hereby agree to abide by all terms
and conditions thereof and all other rules and regulations, including amendments
thereto, prescribed for its use.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________ day of
_______20__ at______________, Makati, Philippines.
Print Name and Signature
to before me this
_________________20__, Affiant exhibited to me his/her residence certificate no.
Doc. No. __________
Page No. __________
Book No. __________
Series of __________
EVALUATION AND RECOMMENDATION
for INCLUSION to PS License subject to satisfactory
for REDUCTION from PS License
Evaluated and Recommended by:
Product Certification Officer
Note: If the PS applicant is foreign, this application shall be authenticated by the Philippine Embassy that covers the plant location.