(Region, Province) Republic of the Philippines

Department of Interior and Local Government

(Name of Station)
BUREAU OF FIRE PROTECTION OPS No.
(Address of Station) Date:
ORDER OF PAYMENT
NAME OF ESTABLISHMENT/PROJECT:
LOCATION:
OWNER/NAME OF REPRESENTATIVE:
FIRE SAFETY CLEARANCE APPLYING FOR:
Fire Safety Evaluation Clearance (FSEC) Fire Safety Inspection Certificate (FSIC) Others: (Pls indicate)
APPLICABLE FEES (Fill-up)
BASIS OF
ACCOUNT
NATURE OF PAYMENT COMPUTATIO TOTAL
CODE
N
Fire Code Construction Tax (0.10% of the verified estimated value of buildings or structures to be erected, from the 628-BFP-01
owner thereof, but not to exceed to PhP 50,000.00)
Fire Code Realty Tax (0.01% of the assessed value of buildings or structures annually payable upon payment of 628-BFP-02
the real estate tax, except on structures used as single family dwellings)
Fire Code Premium Tax (2% of all premiums, excluding re-insurance premiums for the sale of fire, earthquake and 628-BFP-03
explosion hazard insurance collected by companies, persons or agents licensed to sell such insurances in the
Philippines)
Fire Code Sales Tax (2% of gross sales of companies, persons or agents selling firefighting equipment, appliances 628-BFP-04
or devices, including hazard detection and warning systems)
Fire Code Proceeds Tax (2% of the service fees received from fire, earthquake, and explosion hazard reinsurance 628-BFP-05
surveys and post loss service of insurance adjustment companies doing business in the Philippines directly through
agents)
Fire Safety Inspection Fee (15% of all fees charged by the Local Government Unit or Philippine Economic Zone 628-BFP-06
Authority (PEZA), but in no case shall be lower than PhP 500.00)
Storage Clearance Fee( based on the storage capacity as indicated on RIRR of RA 9514 Section 12.0.0.4) 628-BFP-07
Calcium carbide Pyroxylin Matches Nitrate, etc.
Shredded Tar, resin etc. LPG for bulk LPG other than bulk storage
combustible storage
materials Other Flammable Gases Flammable liquids having flash point of -6.67 °C or
below
Flammable liquids having flash point of Liquids having flash point of 22.8°C to 93.3 °C
above -6.67 °C and below 22.8 °C Combustible liquids having flash point greater than
93.3 °C
Conveyance Clearance Fee ( based on their capacity as indicated on RIRR of RA 9514 Section 12.0.0.4) 628-BFP-08
Installation Clearance Fee( refer to Section 12.0.0.4 of the RIRR of RA 9514) 628-BFP-09
Fire Code Administrative Fines (Fire Code Administrative Fines is based on RIRR of RA 9514 Section 12.0.0.4) 628-BFP-10
Other Fees ( refer to Section 12.0.0.4 of the RIRR of RA 9514) 628-BFP-
11-a
Fireworks Fumigation/Fogging Fire Drill Fire Prevention and Safety Seminar
Display
Electrical Fire Incident Appeal Soundstage and Approved Production
Installation Clearance Fee Facilities and Locations
Filing Fee for Protest Fee Open
FSEC Flame
 (Region, Province) Republic of the Philippines
Department of Interior and Local Government
(Name of Station)
BUREAU OF FIRE PROTECTION OPS No.
(Address of Station) Date:
ORDER OF PAYMENT
Certified True Copy of FSEC/FSIC/ Other Clearances Welding, Cutting and Other Hotworks
Certificate of Competency (COC) Fees 628-BFP-
11-b
TOTAL AMOUNT OF FIRE CODE FEES:
TOTAL AMOUNT (IN WORDS):
Official Receipt No. : Amount Paid: Payment Date:

Name and Signature of Fire Code Fee Assessor

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE
EXTINGUISHER”
BFP-QSF-FSED-030 Rev. 02 (11.27.19) “FIRE SAFETY IS OUR MAIN CONCERN”