BLR Form No.

10-CBA, Series of 2003

(For Collective Bargaining Agreement)


Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. ___


APPLICATION FOR CBA REGISTRATION

INSTRUCTIONS: Parts I & II shall be accomplished by the applicant. Supply all required information.


Part I. General Information

A. Parties

Date Accomplished:

A.1 Name of Establishment/Company



Address

Tel. No.

A.2 Name of Union

Address

Tel. No.



Affiliation of Union, if any (State the name of the
Federation/National Union)



Registration Cert. No./Cert. of Local Creation No.:

Date Registered: _________________

Office which Issued Registration Certificate/
Certificate of Local Creation:
[ ] Regional Office No. _____
[ ] Bureau of Labor Relations


A.3 Representation status acquired through:
[ ] Certification/Consent Election
[ ] Voluntary Recognition


Date certified as winner (CE):
Date when VR was recorded by DOLE:

A.4 Type of industry where the parties operate:


A.4 Product Line:



B. Coverage of the Bargaining Unit

B.1 Composition: [ ] Supervisory [ ] Rank-and-File
B.2 Structure: [ ] Employer Unit [ ] Occupational Unit
B.3 Sectoral Classification: [ ] Industry [ ] Services [ ] Agriculture
B.4 Occupational Classification:
[ ] Technical [ ] Administrative [ ] Faculty
[ ] Professional [ ] Manufacturing [ ] Sales/Marketing
B.5 Mode of Payment of Wages:
[ ] Monthly-paid [ ] Daily-paid [ ] Hourly-paid [ ] Task/pakiao [ ] Commission


C. Number of Employees

In the Establishment
Male ____ Female ____


Bargaining Unit
Male ____ Female ____

Union Members
Male ____ Female ____

D. Duration/Period/Status of Agreement

D.1 Ratification

Date Ratified:

Number of Ratifying Signatures:

D.2 Duration/Effectivity

From:

To:

D.3 Status of Agreement
[ ] First [ ] Renegotiated*
[ ] Renewal
[ ] 1
st
Renewal
[ ] 2
nd
Renewal
[ ] 3
rd
Renewal
[ ] 4
th
Renewal

*No registration fee for renegotiated CBA


Part II. Labor Union and Company/Employer Representatives Attestation/Certification


We, _____________________________, President of the ____________________________________,
(Union Presidents Name) (Unions Name)

of legal age, residing at ___________________________________________________________________
(Union Presidents Permanent Address)

and ________________________________, ________________________ of the ____________________
(Company Representatives Name) (Company Designation) (Companys Name)

________________________________________ engaged in ____________________________________
(Company Name) (Type of Industry and Product Line)

of legal age, residing at ___________________________________________________________________
(Company Representatives Permanent Address)

after first being sworn in accordance with law, depose and say:

1. That the collective bargaining agreement was posted in two (2) conspicuous places within the
premises of the establishment/company or bargaining unit, and within the place where the union
seeks to operate for a period of five days, from __________________ to _______________;
2. That the total number of employees in the bargaining unit is ________;
3. That the CBA was supported by ______ which is more than majority of the employees/members
of the bargaining unit, which fact is evidenced by the attached document containing the
employees/members names and signatures;
4. That we subscribe to this attestation/certification in compliance with Section 2, Rule XVII of
Department Order No. 40, Series of 2003.


DONE this ____ day of _______________, at _____________________________________________.



________________________________ ___________________________________
Signature Over Printed Name Signature Over Printed Name
(Union President) (Company Representative)
Com. Tax Cert. No. _________________ Com. Tax Cert. No. _________________
Issued on _________________________ Issued on _________________________
Issued at _________________________ Issued at _________________________



SUBSCRIBED AND SWORN TO before me this ___ day of __________________ at _____________
____________________________, the parties herein exhibiting to me their Community Tax Certificates.


NOTARY PUBLIC



Doc. No.
Page No.
Book No.
Series of 200__
















Part III. Processing of Requirements
To be accomplished by the processor in the RO.


Date Received:

A. Checklist of Requirements. Documents 1-4 shall be certified under oath by the representative(s)
of the employer(s) and the labor union(s) concerned. All documents shall be submitted in triplicate
copies: one original copy and two duplicate copies.
[ ] 1. Duly accomplished form
[ ] 2. Copy of the collective bargaining agreement
[ ] 3. A statement that the collective bargaining agreement was posted in at least two conspicuous
places in the establishment or establishments concerned for at least five days before its
ratification (Part II of the Form)
[ ] 4. A statement that the collective bargaining agreement was ratified by the majority of the
employees in the bargaining unit of the employer or employers concerned (Part II of the Form)
[ ] 5. List of employees/members with corresponding signatures who ratified the CBA.

No other document shall be required in the registration of collective bargaining agreement other
than the above-stated requirements.

B. Verification (Processor to verify with the records on file with BLR and RO)
[ ] Verified/checked that the labor organization/union is a registered labor union and a recognized
or certified bargaining agent in the bargaining unit.

C. Payment of Registration Fee
[ ] Registration fee paid under O.R. No. ___________ Date _________
[ ] Registration fee not paid

D. Recommendation on the Application:
[ ] Recommending issuance of CBA certificate of registration considering that the applicant has
complied with all the documentary requirements
[ ] Recommending that a notice be issued for completion of the lacking requirements/certification
under oath/registration as a labor organization
[ ] Recommending denial due to failure to comply with documentary/certification requirements
within ten days from receipt of notice


______________________________
Processor
(Signature over printed name)

___________________
Date


Part IV. Approval/Denial

[ ] Approval of the CBA certificate of registration
[ ] Notification for completion/compliance of lacking requirements
[ ] For signature of the notice of denial.


Recommended by:


________________________ _____________
Director/Head, Field Office Date



Approved for release:


________________________ _____________
Name of Releasing Officer Date