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FAIR TRADE ENFORCEMENT BUREAU

Import Regulation Division
UPRC Bldg. VI, 315 Sen. Gil Puyat Avenue,
1200 Makati City, Philippines
Telephone No.: (632) 403.1417
E-mail address: fteb_ird@dti.gov.ph Website: www.dti.gov.ph

APPLICATION FORM
USED ENGINES, PARTS AND COMPONENTS IMPORTATION
(E.O. No. 156 as amended by E.O. No. 877-A)

Date: AUGUST 05,2018

A. APPLICANT’S INFORMATION
Name of Importer:AMANSARA TRADING TIN:
Address: RM.110 REGINA BLDG.ESCOLTA ST.BINONDO MANILA,PHILIPPINES
Contact Person:GERRY GODOY Tel. No./Fax No./Email Address:

B. DESCRIPTION OF ITEMS TO BE IMPORTED

Description: USED REPLACEMENT PARTS Tariff Heading: 8708.99.99
Quantity: 27 PCS
Invoice No.: 7876-18 Invoice Value: 8,210.00 Invoice Date: AUG. 23,2018
Port of Destination MANILA, PHILIPPINES

C. MODE OF PAYMENT
Name of Supplier: J.J. INTERNATIONAL CO., LTD
Address/Tel No./Fax No./Email Address:
Letter of Credit(L/C) Self-funded Others
Name of Agent Bank:
Address/Tel No./Fax No./Email Address:NABASAMA YOTSUKAIDO CITY,CHIBA ,JAPAN

D. DOCUMENTARY REQUIREMENTS

 a. Properly filled-up application form.

 b. Notarized Affidavit of Undertaking.

 c. Two (2) copies of Proforma Invoice with Date and Number (original and photocopy).
 d. In appropriate cases, applicant may be required to submit a brochure or any pertinent literature
to describe the spare parts to be imported.

E. PROCESSING FEE – Php 300.00/PER APPLICATION

NOTE:
 Change/s in the name of supplier, commodity description, authorized agent bank, number of
units, value, terms of payment should be backed-up by an amendment from FTEB.

JENNYVIE I. SUCALDITO
Name and Signature of Authorized Signatory
Position

CPG-FTEB-IRD-QF-01D/Rev.01/05.11.17
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REPUBLIC OF THE PHILIPPINES)

____________________________) S.S.

AFFIDAVIT OF UNDERTAKING

I, being the authorized signatory of AMANSARA TRADING with office address at RM.110
REGINA BLDG.ESCOLTA ST.BINONDO MANILA,PHILIPPINES after having sworn to in accordance
with the law, hereby depose and state:

1. That as principal signatory, I am authorizing Mr./Ms. GERRY GODOY/MIGUEL PAYAWAL to

be my representative;

2. That this importation covers only parts for replacement as allowed under E.O. No. 156 as
amended by E.O. No. 877-A;

3. That we further bind ourselves to answer for any criminal, civil or administrative case that
may arise relative to the aforesaid importation.

AFFIANT FURTHER SAYETH NAUGHT.

JENNYVIE I. SUCALDITO GERRY GODOY/MIGUEL PAYAWAL

NAME & SIGNATURE OF NAME & SIGNATURE OF
PRINCIPAL SIGNATORY AUTHORIZED REPRESENTATIVE

PROPRIETOR
POSITION

SUBSCRIBED AND SWORN TO BEFORE ME, this _______ day of _______________ 201______
(principal and representative) exhibited their Residence Certificate Nos. ____________ and
___________ issued at __________ on ___________ and at_______ on ________, respectively.

_________________________
NOTARY PUBLIC

Doc. No._________ PTR No. ______________

Page No. _________ Valid Until _____________
Book No. _________ Series of 20 ____________

CPG-FTEB-IRD-QF-01D/Rev.01/05.11.17