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Certificate of Authority Application

NTA application form for certificate of authority

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Republic of the Philippines
Department of Agriculture
NATIONAL TOBACCO ADMINISTRATION
Scout Reyes Street corner Panay Avenue
Quezon City
APPLICATION FOR CERTIFICATE OF AUTHORITY
I.

PERSONAL DATA:
1. Name : ________________________________________________________
Surname

Given Name

Middle Name

2. Address: ______________________________________________________
House No.

Street

Barangay

Municipality

Province

3. Telephone/Fax/CP Number: ________________________________________
4. Comm. Tax Cert.: _____________ Issued At : _____________On: __________
II.

III.

5.
IV.
V.
1.

NAME/S OF TRADING CENTER/S AFFILIATION:
Name of TC/s

Address

TOBACCO TRADING BACKGROUND OF FR:
1. No. of years engaged in tobacco trading ____________________________
2. Type of tobacco: VIRGINIA
BURLEY
NATIVE
3. Volume (kg) of tobacco purchased/delivered based from immediately preceding
trading season;
Virginia_______ Burley_______ Native_______ Total Volume (kg) _________
4. Previous TC Affiliation:
Name of TC/s
Address
5. Area/s of Operation : ____________________________________________

IV. Certificate of Authority Applying for ;
1. Certificate of Authority to buy : VT
2. Areas of operation : ______________

BT
_____________

NT
______________

I hereby certify the correctness of the above information.
________________________
Signature Over Printed Name
RECOMMENDING APPROVAL:
________________________
Branch Manager /
Authorized TPRO

APPROVED:
_________________________
Administrator
Amount Paid (PhP): ____________
O. R. No. : ___________________
Date : _______________________
COP Serial No./s: _____________
COA No.: ____________________
 
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