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Deconsolidator's Application Form

BOC application form for registration of deconsolidators pursuant to CAO no 05-2016 CMO nos 33-2016 and 04-2017 covering cosolidated shipments of balikbayan boxes

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS
1099 Manila
REVENUE COLLECTION AND MONITORING GROUP
LEGAL SERVICE
ACCOUNT MANAGEMENT OFFICE
APPLICATION FORM FOR REGISTRATION OF DECONSOLIDATORS (CORPORATION CATEGORY)
PURSUANT TO CAO NO. 05-2016, CMO NOS. 33-2016 AND 04-2017 COVERING CONSOLIDATED
SHIPMENTS OF BALIKBAYAN BOXES
Note: To be accomplished & signed by principal officer included in the latest GIS

Name of Deconsolidator: ________________________________________________________
Principal Place / Head Office Address: _____________________________________________
____________________________________________________________________________
Warehouse Address: ___________________________________________________________
____________________________________________________________________________
Branch Office/s Address (use separate sheet if necessary):_____________________________
____________________________________________________________________________
TIN: ____________________________ Email Address: _______________________________
Contact No/s: _______________________Mobile No/s. _______________________________
Name of Authorized Principal Officer: ______________________________________________
Position / Designation: _________________________TIN:_____________________________
Residence Address: ___________________________________________________________
____________________________________________________________________________
Email Address: _______________________Contact No.: ______________________________
ENCLOSED ARE THE FOLLOWING SUPPORTING DOCUMENTS (PLEASE CHECK):
____ BCOR Processing Fee (green copy)
____ Original copy of notarized Secretary’s Certificate, attesting that the Board of Directors resolved to
authorize the indicated principal officer to represent the Deconsolidator and to sign the Application Form,
with his/her three (3) specimen signatures, recent 2x2 photo and photocopy of two (2) valid government
issued identification cards
____ Certified true copy of the registration/accreditation certificate from FTEB-DTI /CAB-DOTr
____ Copy of latest GIS
____ List of Consolidator/s with whom the Deconsolidator has existing Service Contract/s (with complete
business address in the Philippines, contact details, and contact person with position and designation)
____ Copy of the individual Service Contract/s between the Deconsolidator and the Consolidator/s with all
the annexes. (Note: the service contract shall contain all information required pursuant to CMO Nos. 332016 and 04-2017)
____ Affidavit of Undertaking, signed by the authorized principal officer, stating that: (1) the Deconsolidator
shall be obliged to answer for the various charges that may be incurred by the Bureau the Customs such
as storage, arrastre, shipping demurrage, stripping and stuffing charges and other incidental expenses not
otherwise chargeable against the forfeiture bond, in case of implied abandonment of the goods; and (2)
that the Deconsolidator will not transact with the Bureau of Customs, unless it has a valid FTEB-DTI / CABDOTr registration / accreditation
____ Print out of CPRS application form
____ Print out of “STORED” email notification from the BOC
I hereby certify under oath that all the above information are true and correct, all documents have
been verified by the undersigned and are correct, complete and true; and that any misrepresentation and/or
manifestation of fraud in this application shall be a ground for the disapproval of this application,
suspension/cancellation of the Deconsolidator’s registration and blacklisting of the Deconsolidator, as well
as the undersigned.

____________________________________________
Name of Authorized Principal Officer & Signature
Date: _________________

SUBSCRIBED AND SWORN to before me this _____ day of _____________ in ___________,
Philippines, affiant exhibiting to me his/her ______________ issued at _____________ on ____________.
Doc. No.
Page No.
Book No.
Series of 2017

Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS
1099 Manila
REVENUE COLLECTION AND MONITORING GROUP
LEGAL SERVICE
ACCOUNT MANAGEMENT OFFICE
APPLICATION FORM FOR REGISTRATION OF DECONSOLIDATORS (SINGLE PROPRIETORSHIP
CATEGORY) PURSUANT TO CAO NO. 05-2016, CMO NOS. 33-2016 AND 04-2017 COVERING
CONSOLIDATED SHIPMENTS OF BALIKBAYAN BOXES
Note: To be accomplished & signed by the proprietor

Name of Deconsolidator (DTI-Registered Business Name): _________________________________
Principal Place / Head Office Address: _____________________________________________
____________________________________________________________________________
Warehouse Address: ___________________________________________________________
____________________________________________________________________________
Branch Office/s Address (use separate sheet if necessary): _____________________________
____________________________________________________________________________
TIN: _____________________________ Contact No../s: ______________________________
Mobile No./s__________________________ Email Address: ___________________________
Name of Proprietor: ____________________________________________________________
Residence Address: ____________________________________________________________
ENCLOSED ARE THE FOLLOWING SUPPORTING DOCUMENTS TO THIS APPLICATION
(PLEASE CHECK):
____ BCOR Processing Fee (green copy)
____ Certified true copy of the registration/accreditation certificate from FTEB-DTI /CAB-DOTr
____ Copy of DTI Business Name Registration
____ Original Personal Profile of Proprietor with recent 2x2 photo and three (3) specimen
signatures
____ Two (2) valid government issued identification cards of proprietor
____ List of Consolidator/s with whom the Deconsolidator has existing Service Contract/s (with
complete business address in the Philippines, contact details, and contact person with position
and designation)
____ Copy of the individual Service Contract/s between the Deconsolidator and the
Consolidator/s with all the annexes. (Note: the service contract shall contain all information
required pursuant to CMO Nos. 33-2016 and 04-2017)
____ Affidavit of Undertaking, signed by the proprietor, stating that: (1) the Deconsolidator shall
be obliged to answer for the various charges that may be incurred by the Bureau such as storage,
arrastre, shipping demurrage, stripping and stuffing charges and other incidental expenses not
otherwise chargeable against the forfeiture bond, in case of implied abandonment of the goods;
and (2) that the Deconsolidator will not transact with the Bureau of Customs, unless it has a valid
FTEB-DTI / CAB-DOTr registration / accreditation
____ Print out of CPRS application form
____ Print out of “STORED” email notification from the BOC
I hereby certify under oath that all the above information are true and correct, all
documents have been verified by the undersigned and are correct, complete and true; and that
any misrepresentation and/or manifestation of fraud in this application shall be a ground for the
disapproval of this application, suspension/cancellation of the Deconsolidator’s registration and
blacklisting of the Deconsolidator, as well as the undersigned.

____________________________________________
Name of Authorized Principal Officer & Signature
Date: _________________
SUBSCRIBED AND SWORN to before me this _____ day of _____________ in ___________,
Philippines, affiant exhibiting to me his/her ______________ issued at _____________ on ____________.
Doc. No.
Page No.
Book No.
Series of 2017

Republic of the Philippines
Department of Finance
BUREAU OF CUSTOMS
1099 Manila
REVENUE COLLECTION AND MONITORING GROUP
LEGAL SERVICE
ACCOUNT MANAGEMENT OFFICE
APPLICATION FORM FOR REGISTRATION OF DECONSOLIDATORS (PARTNERSHIP CATEGORY)
PURSUANT TO CAO NO. 05-2016, CMO NOS. 33-2016 AND 04-2017 COVERING CONSOLIDATED
SHIPMENTS OF BALIKBAYAN BOXES
Note: To be accomplished & signed by one of the partners

Name of Deconsolidator: ________________________________________________________
Principal Place / Head Office Address: _____________________________________________
____________________________________________________________________________
Warehouse Address: ___________________________________________________________
____________________________________________________________________________
Branch Office/s Address (use separate sheet if necessary): _____________________________
____________________________________________________________________________
TIN: ______________________________Email Address: ______________________________
Contact No./s: ________________________ Mobile No./s______________________________
Name of Partner as Authorized Principal Officer: _____________________________________
Position / Designation: _________________________TIN: _____________________________
Residence Address: ___________________________________________________________
____________________________________________________________________________
Email Address: _________________________ Contact No.: ___________________________
Mobile No. _____________________________
ENCLOSED ARE THE FOLLOWING SUPPORTING DOCUMENTS (PLEASE CHECK):
____ BCOR Processing Fee (green copy)
____ Original copy of notarized Partnership’s Certificate, attesting that the Partners resolved to authorize
the indicated partner as the principal officer to represent the Deconsolidator and to sign the Application
Form, with his/her three (3) specimen signatures, recent 2x2 photo and photocopy of two (2) valid
government issued identification cards
____ Certified true copy of the registration/accreditation certificate from FTEB-DTI /CAB-DOTr
____ List of Consolidator/s with whom the Deconsolidator has existing Service Contract/s (with complete
business address in the Philippines, contact details, and contact person with position and designation)
____ Copy of the individual Service Contract/s between the Deconsolidator and the Consolidator/s with all
the annexes. (Note: the service contract shall contain all information required pursuant to CMO Nos. 332016 and 04-2017)
____ Affidavit of Undertaking, signed by the partner as authorized principal officer, stating that: (1) the
Deconsolidator shall be obliged to answer for the various charges that may be incurred by the Bureau such
as storage, arrastre, shipping demurrage, stripping and stuffing charges and other incidental expenses not
otherwise chargeable against the forfeiture bond, in case of implied abandonment of the goods; and (2)
that the Deconsolidator will not transact with the Bureau of Customs, unless it has a valid FTEB-DTI / CABDOTr registration / accreditation
____ Print out of CPRS application form
____ Print out of “STORED” email notification from the BOC
I hereby certify under oath that all the above information are true and correct, all documents have
been verified by the undersigned and are correct, complete and true; and that any misrepresentation and/or
manifestation of fraud in this application shall be a ground for the disapproval of this application,
suspension/cancellation of the Deconsolidator’s registration and blacklisting of the Deconsolidator, as well
as the undersigned.

______________________________________________________
Name of the Partner as the Authorized Principal Officer & Signature
Date: ________________

SUBSCRIBED AND SWORN to before me this _____ day of _____________ in ___________,
Philippines, affiant exhibiting to me his/her ______________ issued at _____________ on ____________.
Doc. No.
Page No.
Book No.
Series of 2017.
 
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