Republic of the Philippines

City of Caloocan
Office of the City Mayor
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Tel. Nos. 336-5692 / 288-8811 Local 2248 / 2217

Application Form for Business Permit

TAX YEAR ___________

New Renewal Additional Transfer Amendment Mode of Payment

Ownership From Single to Partnership From Partnership to Corporation Annually
Location From Single to Corporation From Corporation to Single Bi-annually
From Partnership to Single From Corporation to Partnership Quarterly

Application No.: Date of Application:

DTI/SEC/CDC Registration No.: Date Issued:
Kind of Organization: TIN:
Last Name First Name Middle Name
Name of Taxpayer:

Business Name:
Trade Owner/Franchise/Name:
Name of President/Treasurer of Corporation: Capitalization:
Business Address Owners Address
House No./Bldg. No.: House No./Bldg. No.:
Building Name: Building Name:
Unit No.: Unit No.:
Street: Street:
Barangay: Barangay:
Subdivision: Subdivision:
City/Municipality: City/Municipality:
Province: Province:
Tel. No.: Tel. No.:
Email Address: Email Address:
Business Establishment SSS Identification No.:
Business Area (in sq.m.): Total No. of Employees No. of Delivery/Service Vehicle/s: Type of Vehicle/s Used:
Male: Female:
In case of emergency, Contact Person:
Tel./Mobile No./Email Address:
If Place of Business is Rented, please identify the following: Monthly Rental: Rent Started:
Lessors Name: (Month/Year)
Last Name First Name Middle Name

Lessors Address
House No./Bldg. No.: Subdivision:
Street: City/Municipality:
Barangay: Province:
Tel. No.: Email Address:
Last Years Gross Last Years Gross
Line/s of Business Line/s of Business
Sales/Receipts Sales/Receipts
Manufacturer / Producer Lessor
Service / Contractor Financial Establishment
Wholesaler Food Service
Retailer Real Estate/Subd. Dealer
Warehouse Others
Specify Products / Services:

I/We declare under the penalty of perjury that the foregoing statements are true and correct to my/our knowledge and I/We have
complied with all laws and regulations governing the establishment, maintenance and operation of my/our business. Further, I/We agree to the
immediate cancellation of this permit by the Business Permits and Licensing Office and/or closure of the establishment should the BPLO
discover/find any falsehood and/or misrepresentation in this application.

______________________________________
SIGNATURE OF APPLICANT OVER PRINTED NAME
______________________________________
POSITION/TITLE

For corporation, only the responsible person (President, Chief Accountant and Corporate Secretary) should sign the form. In case of
Liaison Officer or any authorized representative, kindly present an authorization letter signed by the responsible person of the corporation.