Applicationform Cba

PM-NCR 03.13-F.
01
BLR Form No. 10-CBA, Series of 2003

(For Collective Bargaining Agreement)
Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
NATIONAL CAPITAL REGION
APPLICATION FOR CBA REGISTRATION
INSTRUCTIONS: Parts I & II shall be accomplished by the applicant. Supply all required information.
Part I. General Information Date Accomplished:
A. Parties
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 Registration Cert. No./Cert. of Local Creation No.:
Federation/National Union)
Date Registered: _________________
Office which Issued Registration Certificate/
Certificate of Local Creation:
[ ] Regional Office No. _____
[ ] Bureau of Labor Relations
A.3 Representation status acquired through:

Date certified as winner (CE):
[ ] Certification/Consent Election Date when VR was recorded by DOLE:
[ ] Voluntary Recognition
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 Bargaining Unit Union Members

Male ____ Female ____ Male ____ Female ____ Male ____ Female ____
D. Duration/Period/Status of Agreement
D.1 Ratification D.2 Duration/Effectivity D.3 Status of Agreement

[ ] First [ ] Renegotiated*
Date Ratified: From: [ ] Renewal
[ ] 1st Renewal
Number of Ratifying Signatures: To: [ ] 2nd Renewal
[ ] 3rd Renewal
[ ] 4th Renewal
*No registration fee for renegotiated CBA
PM-NCR 03.13-F.01
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__
PM-NCR 03.13-F.01
Part III. Processing of Requirements Date Received:

To be accomplished by the processor in the FO.
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
______________________________
Evaluator
(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.
Approved/Denied by:
________________________ _____________
Field Office Director Date
Approved for release:
________________________ _____________
Name of Releasing Officer Date

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PM-NCR 03.13-F.

BLR Form No. 10-CBA, Series of 2003

A.2 Name of Union Address Tel. No.

A.3 Representation status acquired through:

B. Coverage of the Bargaining Unit

B.1 Composition: [] Supervisory [ ] Rank-and-File

In the Establishment Bargaining Unit Union Members

D.1 Ratification D.2 Duration/Effectivity D.3 Status of Agreement

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

We, _____________________________, President of the ____________________________________,

________________________________________ engaged in ____________________________________

DONE this ____ day of _______________, at _____________________________________________.

SUBSCRIBED AND SWORN TO before me this ___ day of __________________ at _____________

Part III. Processing of Requirements Date Received:

C. Payment of Registration Fee

D. Recommendation on the Application:

Part IV. Approval/Denial

[ ] Approval of the CBA certificate of registration

Approved for release:

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We, _, President of the ________,

____ engaged in

DONE this day of _, at ___________________________________.

SUBSCRIBED AND SWORN TO before me this _ day of ____ at _