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Application for New Authorization of PETC

LTO application form for PETC new authorization

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Department of Transportation & Communications
LAND TRANSPORTATION OFFICE
East Avenue, Quezon City
Application for New Authorization 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

Testing Equipment (Brand New)
Opacimeter
Gas Analyzer
Brand: ____________
Model: ____________
S/N:
____________

_____________
_____________
_____________

Note: Continue on separate paper if more than one lane
and/or if necessary

IT Service Provider
Number of lane/s applied for authorization

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

EXPIRATION DATE

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 DTI Accreditation Certificate;
4. Certified true copy of the Business Permit (Mayor’s Permit);
5. Bureau of Internal Revenue (BIR) Registration and Tax Identification Number (TIN);
6. SSS Membership Certificate;
7. 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;
8. Location map and layout of the center, including dimensions;
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, including the Certificates of Competency as an MVECT issued by TESDA;
11. List of all equipment, including manuals, reference materials required for the calibrations and test, manuals of
the test procedures and personnel;
12. Procedure for handling of complaints;
13. Certificate of Conformity from the DENR that the testing equipment is in compliance with R.A. No. 8749;
14. Certificate showing that the testing equipment used is interfaced with the system of the PETC IT Service
Provider;
15. Picture of the Establishment;
16. PETC Contract with an authorized IT Service Provider
17. Oath of undertaking that the PETC;
a. has no DOTC/LTO official/personnel, his/her spouse, or relative by consanguity or affinity within the
third (3rd) 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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