Unified Application Form For Business Permit

UNIFIED APPLICATION FORM FOR BUSINESS PERMIT
(Date of Application)
Payment Date of Receipt ___________________
Tracking Number (Application Number)
___________________
NEW Annually
RENEWAL Bi-annually Business ID Number ___________________
(Business Account Number)
ADDITIONAL Quarterly
A. BUSINESS INFORMATION AND REGISTRATION
Please choose one Sole Proprietorship One Person Corporation Partnership Corporation Cooperativ
Male Female Male Female
DTI/SEC/CDA Registration Number: Tax Identification Number (TIN):
Business Name:
Trade Name/Franchise (If applicable):
Main Office Address: House/Bldg. No. ____________ Name of Building: _________________ Lot No. ______________ Block No. _
Street: _________________________ Barangay: _______________________________________ Subdivision: ________________
City/Municipality: ______________________________ Province: __________________________ Zip Code: ______________
Telephone No.: Mobile No.: Email Address:
(For Sole Proprietorship) Surname Given Name Middle Name Suffix

Name of Owner:
(For Corporations/Cooperative) Surname Given Name Middle Name Suffix

Name of President/Officer in
Charge:
For Corporation: Filipino Foreign
B. BUSINESS OPERATION
Business Area (in sq. m): Total No. of Employees in Establishment No. of Employees No. of Delivery Vehicles (If appl
Total Floor Area (in sq. m): ______ Male _______ Female Residing within ______ _______Van/Truck _____ Mo
Same as Main Office Address
Business Location Address: House/Bldg. No. _____ Name of Building __________________________ Lot No. ______ Block No. _
Street _______________________ Barangay _________________________________________ Subdivision __________________
City/Municipality ____________________________ Province ___________________________________ Zip Code _____________
Owned? Yes No If Yes, Tax Declaration No. __________________ or Property Identification No. _______________
Total Capitalization (PH):

Do you have tax incentives from any Government Entity? Yes (Please attach a copy of your certificate) No
Business Activity (Please check one) : Main Office Branch Office Admin Office Only Warehouse Others Pls. Specify ______
Line of Business Philippine Standard Industrial Code Products/Services No. of Units Last Year’s Gross Sales/
(If Available)
I DECLARE UNDER PENALTY OF PERJURY that all information in this application are true and correct based on my personal knowledge and
authentic records submitted to the Municipality of Bacnotan. Any false or misleading information supplied, or production of fake/falsified
documents shall be grounds for appropriate legal action against me and automatically revokes the permit. I hereby agree that all personal
data (as defined under the Data Privacy Law of 2012 and its Implementing Rules and Regulations) and account transaction information or
records with the City/Municipal Government may be processed, profiled or shared to requesting parties or for the purpose of any court,
legal process, examination, inquiry and audit or investigation of any authority.
____________________________________________________
SIGNATURE OF APPLICANT/OWNER OVER PRINTED NAME
_________________________________
DESIGNATION / POSITION / TITLE
ANNEX 1 (Page 2 of 2) Application Form for Business Permit
II. LGU SECTION (Do Not Fill Up This Section)
1. VERIFICATION OF DOCUMENTS
Description Office/Agency Yes No Not Needed
Occupancy Permit (For New) Office of the Building Official
Barangay Business Clearance (For Renewal) Barangay
Sanitary Permit/Health Clearance Municipal Health Office
Market Clearance (For Stall Holders) Office of the Municipal Market Supervisor
Valid Fire Safety Inspection Certificate Bureau of Fire Protection
Municipal Environmental Certificate Municipal Environment and Natural
Resources Office
Verified by:
BPLO
___________________________
2. ASSESSMENT OF APPLICABLE FEES
Local Taxes Amount Due Penalty /Surcharge Total
Gross Sales Tax
Tax on Delivery Vans/Trucks
Tax on Storage for Combustible/Flammable
of Explosive Substance
Tax on Signboard/Billboards
REGULATORY FEES AND CHARGES
Mayor’s Permit
Garbage Charges
Water Fee
Business Plate No.
Sticker
Delivery Trucks/Vans Permit Fee
Health Certificate Fee
Sanitary Inspection Fee
Retail –Cigars & Cigarettes
Retail – Fermented Liquor
Retail – Domestic Liquor
Electrical Inspection Fee
Mechanical Inspection Fee
Plumbing Inspection Fee
Signboard/Billboard Renewal Fee
Storage and Sale of Combustible/Flammable
or Explosive Substance
Others
TOTAL FEES for LGU
FIRE SAFETY INSPECTION FEE (15%)
Assessed by: FSIF Assessment Approved by: BFP
FELISA B. VALDEHUEZA ____________________________________

Acting Municipal Treasurer
III. MUNICIPALITY FIRE STATION SECTION
DATE: _________________
APPLICATION NO.:_____________________
(TO BE FILLED UP BY APPLICANT/OWNER)
Name of Applicant/Owner: __________________________________________________________________________
Name of Business: _________________________________________________________________________________
Total Floor Area: _____________________ Contact No.: _____________________________
Address of Establishment: _________________________________________________________________

_______________________________
Signature of Applicant/Owner
Certified by: FIRE SAFETY INSPECTION
FEE ASSESSMENT:
Costumer Relations Officer
Time and Date Received: ___________________
Important Notice: As per Section 12 of the Implementing Rules and Regulations of the Fire Code of 2008, certain establishments (e.g.
building lessors, fire earthquake, and explosion hazard insurance companies, and vendors of firefighting equipment, appliances and
devices) may be required to pay additional charges and fees other than the Fire Safety Inspection Fees. These shall be collected during
inspections or in another process to be communicated by representative of the Bureau of Fire Protection (BFP).

Unified Application Form For Business Permit

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UNIFIED APPLICATION FORM FOR BUSINESS PERMIT

Trade Name/Franchise (If applicable):

(For Sole Proprietorship) Surname Given Name Middle Name Suffix

(For Corporations/Cooperative) Surname Given Name Middle Name Suffix

Total Capitalization (PH):

FELISA B. VALDEHUEZA ____________________________________

Name of Applicant/Owner: __________________________________________________________________________

Name of Business: _________________________________________________________________________________

Total Floor Area: _ Contact No.: _________

Address of Establishment: _________________________________________________________________

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