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2 Application for New Authorization of PETC IT Service Provider

LTO application form for new authorization of PETC IT service provider

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Department of Transportation & Communications
LAND TRANSPORTATION OFFICE
East Avenue, Quezon City
Application for New Authorization of PETC IT Service Provider
Name of Business
Business Address
Contact Number
Type of Organization (Please Check)
Corporation
Partnership
Sole Proprietorship
Cooperative
Client Application Program

Owner/President
Category (Please Check)
Small (Capital of 1 to 15 million)
Medium (Capital of 15 to 100 million)
Large (Capital of over 100 million)
Version

Documentary Requirements (Please present the originals)
1. Duly accomplished application form, under oath;
2. Certified true copy/ies of the following;
a. For sole proprietorship, Certificate of Business Name Registration (DTI);
b. For corporation/partnerships, Securities and Exchange Commission Certificate of Registration,
Articles of Incorporation/Partnership and By-Laws and Board Resolution certified by the Corporate
Secretary, specifying the name of the authorized representative who must be an officer of the
corporation/partnership;
c. For Cooperatives, Cooperative Development Authority Certificate of Registration, Articles of
Cooperation and By-Laws, and Board Resolution, certified by the Corporate Secretary, specifying the
name of the authorized representative who must be an officer of the cooperative.
3. Certified true copy of the Business Permit (Mayor’s Permit);
4. Bureau of Internal Revenue (BIR) Registration and Tax Identification Number (TIN);
7. SSS Membership Certificate;
8. Audited Financial Statement for the two (2) years or a Pre-operating Financial Statement, whichever is
applicable, showing that the owner-applicant shall be of such financial capacity to operate for at least one (1)
year;
9. Organizational structure showing the relationship between the center and other operation of the firm when
applicable, and the structure of the center showing its personnel and their functions;
10. List of personnel involved in the operation of the center with their job descriptions, responsibilities and
qualifications;
11. List of all equipment, including manuals, reference materials;
12. Procedure for handling of complaints;
13. Picture of the Establishment;
14. Oath of undertaking that the PETC IT Service Provider;
a. has no DOTC/LTO official/personnel, his/her spouse, or relative by consanguity or affinity within the
rd
third (3 ) civil degree with ownership of or any beneficial and/or financial interest therein;
b. that his/her spouse, or relative by consanguity or affinity within the third (3rd) civil degree has no
ownership of or any beneficial and/or financial interest with the PETC and LTO IT System Provider.
Software and Hardware Requirements
1. Client Application Users Manuals;
2. System Set-up and Network layout;
3. System Documentation;
o Complete description of executable file of the Client Program
o System Security Policy
o Declaration and list of main application sub-programs or other files associated with the submitted Client
Application; and
o Screen shots of folder location, file(s) location and size for each and every system files
4. List of PETC Clients with the following description for each;
o System set-up and network lay-out
o Network of stations utilized, date of initial installation, and last system update
5. Certificate of installation of Client Application per PETC; and
rd
6. Screen shots of any third (3 ) party emission test software being used by the Client Application Program
[application location, file(s) and size(s)].
7. Client Application Program Source Code
8. Interfacing Software
_________________________
Printed Name and Signature

____________________
Designation

Subscribed and sworn to me before this _____ day of ___________________, affiant exhibiting to me his/her
Residence Certificate No. ____________________ issued at _______________on __________________________.
Doc. No. __________
Page No. _________
Book No. _________
Series of __________

 

NOTARY PUBLIC
 
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