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Application for Accreditation

AFAB application form for accreditation

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APPLICATION FOR ACCREDITATION
Republic of the Philippines
Office of the President
THE AUTHORITY OF THE FREEPORT AREA OF BATAAN

TO BE FILLED OUT ONLY BY AFAB PERSONNEL

Application No.
Date filed:
Application Fee: PhP 1,200.00
O.R. no.

Instructions: Please accomplish this form by providing the required information on appropriate spaces. Do not leave any blank space, indicate “N/A” if not applicable and
attach additional sheet/s as Annexes if necessary. Only complete set of documents will be accepted for processing.

I. BASIC INFORMATION
1. Name of Company: Please write the company’s full name legibly.

2. Office Address: Write or type the company’s full address. Place one letter on each box. Leave one box blank between names.

3. T.I.N. (Tax Identification Number)

No. / Building

4. Type of Organization:

Street& Barangay

City / Town
Province

Corporation
Sole Proprietorship
Partnership

Zip Code

5. Office Contact Information: Write or type your company’s full contact details.
Telephone No.

Fax Number

Telephone No.

E-mail Address

6. Nature of Business: Please check all that applies.
Customs Brokerage

Construction

Courier Service

Freight Forwarding

Insurance Agency

Maintenance and Supply

Manpower Agency

Security Agency

Trucking

Others (Please Specify): ____________________________________

Scrap Buying

7. Name of Contact Person: Write or type the full name in the ff. sequence: LAST, FIRST, MIDDLE NAME. Place one letter on each box. Leave one box blank between names
LAST
Staple here

FIRST

|

Staple a recent
ID picture (Taken within
the last 6 months)
1.5 in X 2 in
(passport size)

MIDDLE

8. Contact Information of Contact Person: Write or type contact person’s full contact details.

Please print your name
at the back of the photo.

Telephone No.
Cellphone No.

Staple here

|

E-Mail Address

I affirm that:
(1) All the information provided in this application form, and all submitted documents are true, complete, and accurate;
(2) I will abide by the rules and policies set by the Authority of the Freeport Area of Bataan (AFAB).
I am aware that any or all the information furnished in this application may be checked against the original documents and that withholding information or giving
false information, as well as violations on my part of any of the AFAB’s policies, rules and regulations will disqualify me from approval of application/will be a basis
for revocation of certificate, if approved. I also understand that no results for my application may be released until all requirements are satisfied.
Furthermore, I understand that all information I provide in this form and submitted documents may be used by the Authority for research and background
check, and I consent to such with the assurance that my personal details will be kept secure.
_________________________
Date

________________________________
Signature over Printed Name

AFAB-07-05-05_FM_Application for Accreditation

Page 2 of 2

APPLICATION FOR ACCREDITATION
If application is to be processed by an authorized personnel, please fill out the following section. Otherwise, leave it blank.
Name of Authorized Personnel:

Valid I.D. Presented:

____________________________________________________________
(Surname)
(First Name)
(M.I.)

Signature:

ID Presented: ______________________
ID Number: ______________________

Please attach Letter of Authority, designating the person named above as the authorized personnel, signed by the applicant.
Do NOT write anything after this part.TO BE FILLED OUT ONLY BY AFAB PERSONNEL
II. REQUIRED DOCUMENTS
Basic Requirements



























Letter of Intent addressed to the Chairman and Administrator
Company Profile (w/ completed/ongoing projects of company)
List of Company Officers
Personal History Statement of Principal Officers –
Bio data with 2x2 ID Picture
Articles of incorporation and By-laws
(For Partnership/Corporation)
Certified True Copy of BOC Registration
Certified True Copy of DTI Registration
Certified True Copy of SEC Registration
(For Partnership/Corporation)
Certified True Copy of CDA Certificate of Registration
(For Cooperative)
BIR Certificate of Registration (BIR Form 1556/2303)
Certified True Copy of Latest Income Tax Return (ITR)
Latest Audited Financial Statement or Certificate of Accounts
from the Bank Manager (original)
Certified True Copy of SSS Certificate of Membership
Certified True Copy of Pag-Ibig Certificate
Certified True Copy of Philhealth Certificate
Certified True Copy of Dole Registration Rule1020 of OSHS
Mayor’s Permit
(for the current year, if outside the FAB)
Lease Contract /Locational Clearance & Zoning Compliance
Certification
(if inside the FAB)
List of non-FAB clients
List of employees to be assigned in FAB
Drug-Free Workplace Policies (Company w/ over 10 employees)
Certification / Endorsement from FAB Locator (original)or
List of prospective FAB Clients (from applicant)
– Please include all the FAB Enterprise/s you are applying at, and
the respective contact person/s.
Others (Please specify):
________________________________
________________________________
________________________________





























ADDITIONAL REQUIREMENTS for Special Type of Services
For Brokerage
Certified True Copy of PRC Broker’s License/Broker’s Bond
AMO Accreditation
For Sea Freight
Annual Permit to Operate/Clearance from Philippine Ports Authority
Certificate of Accreditation from the Philippine Shippers Bureau
For Air Freight
Authority to Operate from the Civil Aviation Authority of the Philippines
For Trucking / Supplier
General Cargo Bond for Land Carrier
OR/CR of Vehicles
For Construction
Certified True Copy of PCAB License
Occupational Health and Safety Program
List of Equipment
For Security Agency
PNP Clearances:
a. PNP Regular Permit to Operate or Temporary License to Operate
b. Updated Firearm Licenses
Latest Disposition Report validated by PNP-SAGSD
Bond with PNP
List of Equipment
Certification from AFAB Police
For Manpower Agency
Certified True Copy of DOLE Registration D.O.18-A
For Hazardous Waste Disposal
Certified True Copy of DENR Permit
Oil Spill Contingency Plan
List of Equipment
For Insurance
Certified True Copy of Philippine Insurance Commission Accreditation
For Pest Controllers
Certified True Copy of FPA License
For Landscaping
Certified True Copy of Professional Board Accreditation
For Consultancy
Certified True Copy of Professional Board Accreditation
Cost of Services
For Printing
Accreditation of Publisher’s Association
For Healthcare
Cost of Services

Application for Accreditation Fee is PhP 1,200.00(to be paid upon submission of complete requirements)
Accreditation Fee(to be paid once the Accreditation has been approved and Certificate of Accreditation has been signed):
- PhP 4,800.00 (For Scrap Buyers, Accreditation Fee is Php3,600.00)
If you have any questions or inquiries, please feel free to contact the Registration Division at (047) 935-4004 loc. 8115 or (02) 236-5010 loc. 8115.
Received this ______ day of ________________ 20__.

Processed and Evaluated by ___________________________

AFAB-07-05-05_FM_Application for Accreditation
 
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