SEARCH
Philippine Government Forms All in One Location
Tweet
Share
Application Form
NMIS application form for cold storage warehouse
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Agriculture
OFFICE OF THE SECRETARY
Elliptical Road, Diliman
Quezon City 1100, Philippines
APPLICATION FOR COLD STORAGE WAREHOUSE
1. Date of Application
2. Type of Application
New
Renewal
3. TIN
4. Company Name, address, telephone / fax number (including area code)
5. Plant Location
6. Name of Applicant, mailing address, telephone / fax number (including area code)
7. No. of days/month operational ________ 8. No. of shift/day ________ 9. No. of hours/shift ________
10. Product Stored (at the time of application)
Local
1. Meat and Meat Products
2. Fruits/Vegetables and products
3. Eggs/Milk and products
4. Fish and Fish Products
Volume (MT)
____
____
____
____
Imported
Volume (MT)
____
____
____
____
Imported
%
____
____
____
____
11. Percentage Capacity
Local
1. Meat and Meat Products
2. Fruits/Vegetables and products
3. Eggs/Milk and products
4. Fish and Fish Products
%
____
____
____
____
12. Destination of Stored Products (please specify)
Wet Markets ____________________________________________________________________
Hotels/Restaurants _______________________________________________________________
Processors ______________________________________________________________________
Meat/Fish Shop __________________________________________________________________
Supermarket ____________________________________________________________________
Resale __________________________________________________________________________
13. Storage Capacity
Chiller
Blast Freezer
Contact Plate Freezer
Holding Freezer
Dry Warehouse
Others (please specify)
Volume (cubic meter)
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
14. Signature of Applicant (over printed name, position)
________________________________________________
(Signature over Printed Name)
16. Application Received/Verified by:
___________________________________________
(Signature over Printed Name)
Capacity (MT)
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
15. Date Signed __________________
______________________________________
Position / Designation
17. Competent Authority (CA):
____________________________________
Agency
ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES)
_____________________________)S.S
BEFORE ME, a Notary Public for and in the above jurisdiction, this day of
____________________________,
20___,
personally
appeared
Mr./Ms.
__________________________________ of ________________________________________,
(Name of Company Representative)
(Name of Company)
Affiant exhibiting to me his/her ________________________________________ bearing
(Type of Identification i.e. Passport, Driver’s License, SSS)
No. __________________________ issued on ______________________, 20___ and expiring on
____________________, 20___.
Known to me and by me known to be the same person who executed the foregoing
application for accreditation consisting of one (1) page where this acknowledgement is
hereto attached.
WITNESS MY HAND AND NOTARIAL SEAL on the date and at the place first above
written.
Doc. No. ________
Page No. ________
Book No. ________
Series of ________
APPLICATION REQUIREMENTS FOR ACCREDITATION OF
COLD STORAGE WAREHOUSE
I. NEW APPLICATION
1. Duly accomplished and Notarized Application Form
2. Evaluation report and copy of the completed/accomplished Evaluation Criteria Form (by the Competent
Authority)
3. Floor Plan/Layout showing all storage rooms and other facilities for Specific products
4. Recent photographs of the inner and outer portions of the CSW
5. Documentary Requirements
a. Business Permit – City/Municipal Government
b. Environment Compliance Certificate/Certificate of Non-Coverage – DENR
c. Permit to Operate (Air Pollution Source/Control Installations, Exemption Certificate) – DENR/LLDA
* Provided that, in case the cold storage facility is also engaged in the processing of agricultural
and fisheries products, a Waste Water Discharged Permit shall also be required.
d. Photocopy of Business Registration – DTI/SEC
e. Sanitary Permit/Letter of Approval of Water Source and Potability – DOH + NWRB/LGU Health Office
6. Reliable recording system for readily available information
7. Rated Capacity
8. List of clientele for the last two (2) years, where applicable
9. List of products/commodity stored (Local & Imported)
II. RENEWAL OF ACCREDITATION
1. Duly accomplished and verified Application Form
2. Evaluation report and copy of the completed/accomplished Evaluation Criteria Form (by the Competent
Authority)
3. Updated documentary requirements
a. Business Permit – City/Municipal Government
b. Permit to Operate (Air Pollution Source/Control Installations, Exemption Certificate) – DENR/LLDA
* Provided that, in case the cold storage facility is also engaged in the processing of agricultural
and fisheries products, a Waste Water Discharged Permit shall also be required.
c. Sanitary Permit/Letter of Approval of Water Source and Potability – DOH + NWRB/LGU Health
Office
4. List of clientele for the last two (2) years, where applicable
5. Photographs of additional facilities/improvements, if any
