APPLICATION FOR ACCREDITATION & REGISTRATION

(CORPORATION-PARTNERSHIP-COOPERATIVE-RENEWAL)
_______________________
(Date)
Chief, Interim Customs Accreditation & Registration (ICARE) Unit
Intelligence Group
I, ___________________________________________, of legal age, with
postal address at _____________________________________________________
after having been duly sworn in accordance with law, hereby depose and say:
1. That I am the _________________________________________________of
_________________________________________ duly authorized to file this
application for renewal of accreditation and registration with the Bureau of
Customs, as evidenced by the attached written authority from the
company.
2. That I hereby present the following information for accreditation with the
Bureau of Customs
2.1. Name of the Firm __________________________________________
a. Head Office Address _______________________________________
____________________________________________
Year/s of Stay in the premises: _______________________________
Nature of occupation: ( ) owned ( ) leased ( ) shared ( ) others
Proof of Lawful Occupation: ( ) Certificate of Title
( ) Contract of Lease
( ) Usufruct Agreement
( ) Others, specify _____________
b. Warehouse Address ________________________________________
Year/s of Stay in the premises: ________________________________
Nature of occupation: ( ) owned ( ) leased ( ) shared ( ) others
Proof of Lawful Occupation: ( ) Certificate of Title
( ) Contract of Lease
( ) Usufruct Agreement
( ) Others, specify _____________
c. Branch Office ______________________________________________
d. Year/s of Stay in the premises: ________________________________
Nature of occupation: ( ) owned ( ) leased ( ) shared ( ) others
e. Telephone Number/s ________________________________________
f. Facsimile Number/s _________________________________________
g. *Email Address ____________________________________________
h. Company TIN _____________________________________________
*Mandatory Field since Notice of Denial/Approval will be send via
Email

2.2. Person managing the affairs of the firm:

Name:
__________________________________________
Designation:
__________________________________________
Telephone Number: __________________________________________
Specimen Signature: __________________________________________
2.3. List of Officers/Directors (For corporations and partnerships, please attach the
Latest General Information Sheet duly received by SEC)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
3. That I hereby attach herewith the following documents:
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BCOR evidencing payment of registration fee

Printed Copy of CPRS Application
Previous Accreditation Certificate
Authorization of the Applicant
( )
Board Resolution
( )
Secretarys Certificate
( )
Others, specify
Latest General Information Sheet
Affidavit of No Change/Change of Cirsumstance/s (in case of any material
Changes in the circumstances of the company, documents in support thereof
must be presented)
Current Mayors Permit as Importer with Official Receipt (duly certified by the
issuing agency)
Current Barangay Clearance (duly certified by the issuing agency)
Income Tax Return for the past 3 years, if applicable (Duly Certified by the
Issuing Agency)
Value Added Tax Returns for the past 3 years, if applicable (Duly Certified
Issuing Agency)
Valid Government Issued I.D. with Photo
Community Tax Certificate Company
Proof of Ownership of Business Premises
( ) Certificate of Title
( ) Lease Contract
( ) Others: ________________________

4.Other information:
1. Nature of Business (Use separate sheet of necessary)
Main Line of Business:
___________________________________
Secondary Line of Business
___________________________________
Other Business Activities
___________________________________
2. Summary of Previous Importation (Use separate sheet if necessary)
Commodity
_________________________
_________________________

Volume (one year period)

_____________________________
_____________________________

_________________________

_____________________________

3. Capitalization _________________________________________
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) Treasurers Affidavit
) Bank Certification
) Audited Financial Statement
) GIS indicating Paid-Up Capital of the Company
) Others, specify __________________________

4. Interest in other business/enterprise (if any)

Name of Firm
_________________
_________________
_________________
_________________

Nature of Interest
_________________
_________________
_________________
_________________

SEC/DTI Reg. No.

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I hereby certify under oath that all the above information are true and correct;
all documents submitted in support of this application are true copies of the original,
subject for verification; any misrepresentation and/or manifestation of fraud in this
application shall be a ground for the disapproval of my application, and backlisting of
our firm and the undersigned as the applicant.
Very truly yours,
APPLICANTS NAME
By:
___________________________________
T.I.N. __________________________
SUBSCRIBED AND SWORN to before me this ___________ day of
____________________ in Manila, Philippines, affiant exhibiting to me his/her 2
valid government issued IDs: 1. _______________ issued at ________________ on
_________________,
2.
___________________
issued
at
_______________________ on _______________________________.

NOTARY PUBLIC
Doc No. _____________
Page No. ____________
Book No. ____________
Series of ____________