KMIS - Format - FF Accreditation Application Formrevised - v2

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Fair Trade Enforcement Bureau

Business Licensing and Accreditation Division


APPLICATION FOR ACCREDITATION OF SEAFREIGHT FORWARDERS
G/F, UPRC Building, 315 Sen. Gil J. Puyat Avenue, Makati City 1200 Philippines
Telephone Number: (02) 890 4892  Email Address: fteb_blad@dti.gov.ph

_________________
Date (MM/DD/YYYY)
THE DIRECTOR
Fair Trade Enforcement Bureau (FTEB)
G/F, UPRC Bldg., 315 Sen. Gil J. Puyat Avenue
Makati City, Metro Manila, 1200 Philippines

Sir/Madam:

We are respectfully applying for accreditation pursuant to PSB Administrative Order No. 6, Series of 2005, otherwise known
as Revised Rules on Freight Forwarding, and certify that all the information and documents submitted together with this
application form are true and correct.
We undertake to engage only in activities of the category/ies applied for and approved by FTEB.
We understand and agree that the information will be processed and used by DTI for accreditation related purposes only.

Name of Business:
Business Address:
(House/Building No./Building Name) (Street Name) (Barangay)

(City/Municipality) (Province) (Region) (Zip Code)


Contact Person: Designation:
(Authorized Signatory) (Title) (First Name) (Middle Name) (Last Name) (Suffix)
Sex: ❑ Male ❑ Female Social Classification: ❑Abled ❑Differently Abled ❑Indigenous Person
❑Senior Citizen ❑ Youth ❑ Out-of-School Youth
Asset Size: ❑Micro (<PhP3M) ❑Small (PhP3M - 15M) ❑Medium (PhP15M - 100M) ❑Large ( >PhP100M)
Form of Organization: ❑ Sole Proprietorship ❑ Corporation ❑ Partnership ❑ Cooperative
Tax Identification No. (TIN): Total No. of Employees:
Telephone Number: Fax Number:
Mobile Number: Email Address:
Type of Application: Category/ies applied for: (please initial each
❑ New category checked)
❑ Renewal __❑ 1. Non-Vessel Operating Common Carrier
❑ Additional Category: __❑ 2. International Freight Forwarder
❑ Branch: __❑ 3. Domestic Freight Forwarder

All personal data collected herein shall be processed according to the principles and provisions of the Data Privacy Act of 2012
(DPA), its Implementing Rules and Regulations (IRR), and National Privacy Commission (NPC) issuances.

_________________________________________
Signature over Printed Name of Authorized Signatory
Republic of the Philippines )
City/Municipality/Province of________ ) SS

Subscribed and Sworn to before me this ________ day of ___________ 20______ in the City/Municipality/Province of
____________________; affiant exhibiting to me his/her valid government issued ID ___________________ issued at
_____________ on _____________ valid until ____________.

Notary Public
Until December 31, 20____
Doc. No.: ______
Page No.: ______
Book No.: ______
Series of: 20____.

CPG-FTEB-BLAD-Form No.16/rev.02/06.21.19

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