UNIFIED APPLICATION FORM FOR BUSINESS PERMIT

OFFICE OF THE CITY TREASURER

BUSINESS PERMIT & LICENSING DIVISION
ANNEX 1 (PAGE 1 OF 2)

_______________________ ___________- 2024

Business Registration Plate No. TAX YEAR _____________
Control No.
CITY/MUNICIPALITY _________________
INSTRUCTIONS:
1. Provide accurate information and print legibly to avoid delays. Incomplete form will be returned to the applicant.
2. Ensure that all documents attached to this form (if any) are complete and properly filled out.
I. APPLICATION SECTION
1. BASIC INFORMATION
NEW RENEWAL MODE OF PAYMENT: Annually Semi-Annually Quarterly
Date of Application: DTI/SEC/CDA Registration No. :
TIN No. : DTI/SEC/CDA Date of Registration :
Type of Business : Single Partnership Corporation Cooperative OPC
Amendment : From Single Partnership Corporation Cooperative OPC
To Single Partnership Corporation Cooperative OPC
Are you enjoying tax incentive from any Government Entity? No Yes please specify:
Name of Taxpayer / Registrant
Last Name: First Name: Middle Name:
Business Name :
Trade Name / Franchise :
Name of President: Last name: First Name: Middle Name:
For Corporation: Filipino Foreign
2. OTHER INFORMATION
Business Address : Owner Address :
House/Bldg. No.: House/Bldg. No.:
Bldg. Name: Bldg. Name:
Unit No.: Unit No.:
Street: Street:
Barangay: Barangay:
Subdivision: Subdivision:
City/Municipality: City/Municipality:
Province: Province:
Telephone/Mobile No.: Telephone/Mobile No.:
E-mail Address: E-mail Address:
Business Area (in sq. m.): Total No. of Employees in Establishment: No. of Employees Residing within LGU:
Male: Female: Total:
Note: Fill Up Only if Business Place Is Rented : Business Size on Capitalization (Excluding Land)
Tax Declaration No. ______________ or Property Identification No. _____________
Lessor's Full Name: Micro - 3,000,000.00 or less
Lessor's Full Address: Small - 3,000,001.00 but not more than 15,000,000.00
Lessor's Telephone/Mobile No.: Medium - 15,000,001.00 but not more than 100,000,0
Lessor's Email Address: Large - more than 100,000,000.00
Monthly Rental:
3. BUSINESS ACTIVITY
Philippine Standard No. of Capitalization Last Year's Gross Sales/Receipts (for Renewal)
Line of Business Industrial Code Units (for New Business) Essential Non-Essential

No. of Delivery Vehicles (if applicable):

Van/Truck ______ Motorcycle_______ Motortricycle______

I DECLARE UNDER PENALTY OF PERJURY that the foregoing information in this application are true based on my personal knowledge and
authentic records. Further, I agree to comply with the regulatory requirement and other deficiencies within 30 days from release of the business permit.

___________________________________________________
SIGNATURE OF APPLICANT/TAXPAYER OVER PRINTED NAME

___________________________________________________
DESIGNATION / POSITION / TITLE
ANNEX 1 (Page 2 of 2)
II. LGU SECTION (Do Not Fill Up This Section)
1. VERIFICATION OF DICUMENTS
Description Office/Agency Yes No Not Needed
1. Barangay Clearance (for Business) Barangay
2. Zoning Clearance Zoning Section - City Planning Office
3. Occupancy Permit (For New) Bldg. Official - City Engr.'s Office
4. Cert. of Annual Inspection City Engr.'s Office
5. Sanitary Permit/Health Clearance City Health Office
6. Fire Safety Inspection Certificate Bureau of Fire Protection
7. City Environmental Certificate Dept. of Environment & Natural Resources
8. Market Clearance (For Stall Holders) Office of the City Market Administrator

Verified by: BPLO

________________________________
2. ASSESSMENT OF APPLICABLE FEES
LOCAL TAXES AMOUNT DUE PENALTY/SURCHARGE TOTAL
Gross Sales Tax
Tax on Delivery Vans/Trucks
Tax on Storage for Combustible/Flammable of Explosive Substance
Tax on Signboard / Billboards
REGULATORY FEES AND CHARGES
Mayor's Permit
Garbage Charges
Delivery Trucks/Vans Permit Fee
Sanitary Inspection Fee
Building Inspection Fee
Electrical Inspection Fee
Mechanical Inspection Fee
Plumbing Inspection Fee
Signboard/Billboard Renewal Fee
Storage and sale of Combustible/Flammable
or Explosive Substance
Others
TOTAL FEES for LGU
FIRE SAFETY INSPECTION FEE (10%)

Assessed by: CTO FSIF Assessment Approved by: BFP

____________________________________ _______________________________________

III. CITY/MUNICIPALITY FIRE STATION SECTION

DATE: _________________________
APPLICATION NO.: _______________
(TO BE FILLED UP BY APPLICANT/OWNER)

Name of Applicant/Owner:
Name of Business:
Total Floor Area : Contact No.:
Address of Establishment:

__________________________________________
Signature of Applicant/Owner

Certified by: FIRE SAFETY INSPECTION

Customer Relations Officer FEE ASSESSMENT:
Time and Date Received: ______________________________

Important Notice: As per Section 12 of the Implementing Rules and Regulations of the Fire Code of 2008, certain establishments
(e.g. building lessors, fire, earthquake, and explosion hazard insurance companies, and vendors of fire fighting equipment, appliances
and devices) may be required to pay additional charges and fees other than the Fire Safety Inspection Fees. These shall be collected during
inspections or in another process to be communicated by representatives of the Bureau of Fire Protection (BFP).