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Customer Premises Equipment CPE Accreditation Supplier Permit
NTC permit application form for CPE Accreditation Supplier Permit
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Republic of the Philippines
Office of the President
NATIONAL TELECOMMUNICATIONS COMMISSION
National Capital Region
BIR Road, East Triangle Diliman, Quezon City
Tel. No.: (02) 924-4010 / 426-8215
APPLICATION FOR CUSTOMER PREMISES EQUIPMENT ( CPE )
SUPPLIER ACCREDITATION
ALL BLANKS MUST BE FILLED UP PROPERLY. ALL REQUIREMENTS SHOULD BE
COMPLETED PRIOR TO FILING OF THIS APPLICATION.
NEW
RENEWAL
1. Applicant: ________________________________________________________________________
2. Business Address: __________________________________________________________
_________________________________________________________________________
3. Telephone No.: _______________________ Fax No.: ____________________________
4. Address of CPE Warehouse: __________________________________________________
5. Type of Firm (check appropriate box)
Corporation
Partnership
Proprietorship
6. Has applicant ever been known by another name?
Others (please specify)____________
Yes
No
If yes, list name and address __________________________________________________
__________________________________________________
7. Supporting documents (please see back hereof).
I hereby certify that all the information given above including the attached
supporting documents are true and correct and that any false statement or
misrepresentation made in connection with this application shall constitute a
valid ground for automatic denial of this application.
__________________________________
Authorized Signatory
(signature over printed name )
__________________________________
Position/Official Capacity
SUBSCRIBED AND SWORN BEFORE ME, A Notary Public, This _____th day of ________________
Affiant having exhibited his / her Res. Cert. No. ___________________ issued at ___________________
on ____________________
Doc. No. ____________
Page No. ____________
Book No. ____________
Series of 20__________
Supporting Papers
NEW
Duly certified Security and Exchange Commission (SEC) or Board of Domestic
Trade registration certificate
Copy of Business/Mayor’s Permit
Copy of the latest Financial Statement of the firm prepared by a Certified Public
Accountant (CPA) to include Balance Sheet and Income Statement
Proof of paid up capitalization (minimum of P250, 000.00) duly certified by the
Treasurer of the Corporation or by the partners in a partnership or by the owner
in a sole proprietorship
Copy of valid distributorship or representation agreement on products to be sold
Proof that the CPE to be sold are duly type approved
Contract/Certificate of Employment on one (1) duly licensed Professional
Electronics Engineer (PEcE) and two (2) qualified Radio Communications
Technician and/or Electronics Technician (ECT) employed by the firm on a fulltime basis
RENEWAL
Original Copy of Accreditation Certificate
Copy of Business/Mayor’s Permit
Copy of valid distributorship or representation agreement on products to be sold
Copy of the latest Financial Statement of the firm prepared by a Certified Public
Accountant (CPA) to include Balance Sheet and Income Statement
Type Approval Certificates of the CPEs to be sold (those are not previously
submitted)
Contract/Certificate of Employment on one (1) duly licensed Professional
Electronics Engineer (PEcE) and two (2) qualified Radio Communications
Technician and/or Electronics Technician (ECT) employed by the firm on a fulltime basis
