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Business Name Application Form

DTI application form for business name

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: APPLICATION FOR REGISTRATION AS
BARANGAY MICRO BUSINESS ENTERPRISE (BMBE)
BMBE Form 01
Date Application Filed :___________
Application No._________________

New Renewal

________________________________________

Certificate No. ___________
Date Registered: __________

Name of Business Enterprise
(DTI Business Name/ SEC Registered Name)
DTI Business Name /SEC Registration No/CDA Registration No._____________

Name of Owner (if Sole Proprietor)
(Last Name)
Business
Address

(First Name)

_____ (House/Bldg. No.) ______________________________ (Bldg. Name)

___________ (Unit No.) ____________________________ (Street)
_________________ (Barangay) ________________ (Subdivision)
_______________ (City/Municipality) ______________ (Province)
(if any) _______________________________________________

Branches
Type of Business Organization

Status of Business
Principal Business Activity

Male Female

(Middle Name)

Telephone No.
Mobile No.
Fax No
Email

Single Proprietorship Partnership Corporation Cooperative
Association
Others_______________________
New Existing
Production
Processing
Manufacturing Trading
Services (Excluding those rendered by anyone who is Others______________
duly licensed by the government after having passed a
government licensure examination in connection with the
exercise of one’s profession)

Product Lines/Services
Other Businesses if any





Yes
No
If yes, how many? ____________________________________
Total Assets (To the nearest Thousand Pesos excluding the value of the land on
which the business entity’s office, plant and equipment are located)
Php
Total Number of Employees

No. of Males:
Regular:

No. of Females:
Irregular/Part-time:

UNDERTAKING
I/We hereby declare, for purposes of Section 5 of RA 9178, that all information, including the business enterprise’s asset
size, supplied in this application which shall be the basis of assessing my eligibility for registering as BMBE are true and
correct to the best of my belief and knowledge. Any false or misleading information supplied, and/or production of
materially false or misleading document to support this application shall be ground for disapproval of BMBE
application/revocation of BMBE Certificate of Authority as well as ground for criminal, civil and/or administrative action
against our enterprise. I affirm under the penalties of perjury, that this declaration has been made in good faith.
I/We undertake to advise the Department of Trade and Industry through the Negosyo Center of any change in the status of
its ownership structure and shall surrender the original copy of the BMBE Certificate of Authority for notation of the
transfer.

Applicant’s/Authorized Representative’s Signature
Over Printed Name
 
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