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Application for Special Permit

AFAB application form for special permit

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APPLICATION FOR SPECIAL PERMIT
TO BE FILLED OUT ONLY BY AFAB PERSONNEL

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

Application No.
Date filed:
Application Fee:
O.R. no.

Instructions: Please accomplish this form by providing the required information on appropriate spaces. Do not leave anyblank 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 Owner:Print or type your full name in the ff. sequence: LAST NAME, FIRST NAME, 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

2. Address:Print or type your full address. Place one letter on each box. Leave one box blank between names.
No. & Street

Please print your name
at the back of the photo.

Barangay
City / Town

Staple here

Province

|

Zip Code

3. Contact Information:Print or type your full contact details.

4. Sex:Male / Female
Mobile No.

Tel. No.

5. Civil Status

E-Mail Address
6. Name of Business: Please print the business’ full name legibly.

7. Location of Business: Print or type the full business address. Place one letter on each box. Leave one box blank between names.

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

No. & Street

Barangay
9. Kind of Ownership:
Corporation
Sole Proprietorship
Partnership

City / Town
Province

Zip Code

10. Amount Capital: (in PhP)

11. Products Delivered:

12. Products Delivered to:

I affirm that:
(1) All the information supplied 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.
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 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-07-05-09_FM_Application for Special Permit

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

14. Valid I.D. Presented:

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

15. 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 AND CLEARANCES
Documentary Requirements Submitted:
DTI or SEC Registration
(DTI Registration for single proprietorship, SEC Registration for
partnership or corporations.)

Barangay Business Clearance
(From the barangay where the business is located)

BIR Registration Certificate

Income Tax Return

Valid Government I.D. of Owner

Barangay Clearance of Driver / Delivery Personnel

Government ID Presented: ________________________
Government ID Number:
________________________

FAB Police Clearance Certificate
(From the Public Safety & Security Department)

(From the barangay where the person is from)

Others:
___________________________________________________
___________________________________________________
___________________________________________________
Note: AFAB reserves the absolute right to require other documents that it may
deem necessary to complete its evaluation of the application.

Received this ______ day of ________________ 20__.

Recommending Approval:

Processed and Evaluated by:
___________________________

KARL M.N. ZAPANTA
Department Manager

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.

AFAB-07-05-09_FM_Application for Special Permit
 
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