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2 Application for Renewal of Authorization of PETC

LTO renewal application form for PETC

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Department of Transportation & Communications
LAND TRANSPORTATION OFFICE
East Avenue, Quezon City
APPLICATION FOR RENEWAL OF PETC
Name of Business
Business Address
Contact Number
Type of Organization (Please Check)
Corporation
Partnership
Sole Proprietorship
Cooperative

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)

LTO Service Area
DTI Accreditation Number

IT Service Provider
LTO Authorization Number

LIST OF MOTOR VEHICLE EMISSION CONTROL TECHNICIANS (MVECT)
NAME OF TECHNICIAN
TESDA CERTIFICATE NO.

CALIBRATION CERTIFICATE & EQUIPMENT INFORMATION
OPACIMENTER/BRAND/MODEL/SERIAL NO./
DATE CALIBRATED

EXPIRATION DATE

GAS ANALYZER/BRAND/MODEL/SERIAL NO./
DATE CALIBRATED

DOCUMENTARY REQUIREMENTS (Please present the originals)
1. Duly accomplished application form, under oath;
2. Certified true copy of DTI Accreditation Certificate;
3. Original LTO Certificate of Authorization;
4. Original LTO Certificate of the MVETC;
5. TESDA Certificate of the MVETC;
6. Certified true copy of Mayor’s Permit;
7. Income Tax Return for the current year, duly stamped and received by the BIR;
8. Duly sworn Affidavit attesting to its continuing compliance with all the requirements for authorization, unless
there are changes thereto, in which case the applicant shall submit the applicable documents;
9. Picture of the establishment; and
10. Certificate of Calibration issued by DTI-BPS accredited calibration laboratories.
11. Oath of undertaking that the PETC;
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 IT Service Providers and LTO
IT System Provider.

_________________________
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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