Republic of the Philippines

Department of Labor and Employment

REGIONAL OFFICE NO. _____

APPLICATION FOR REGISTRATION OF JO CONTRACTORS!S"CONTRACTORS
1. Business Name: __________________________________________TIN________________
2. Business Address: ___________________________________________________________
3. Telephone No. __________________a!: ______________"mail: ____________________
#. $ontact Person and Position: ___________________________________________________
%. Areas of &peration: __________________________________________________________
'. Nature of Business: ____________________ (. Industries to be co)ered_______________
*. Number of Re+ular ,or-ers: ______ .ale _____ emale______
/. Names0 Positions and Addresses of &1cers and 2ta3:
Name# of O$%er#!Sta& Po#'t'on Po#tal Addre##
14. 5ist of $lients 6use additional sheet if necessar78
Name and Address
of $lient9Principal
Nature of
Business
2er)ices
Pro)ided to
$lients9Principa
l
:escription of
the Phase of the
$ontract
Number of "mplo7ees
$o)ered in each Phase
of the $ontract
.ale emale
11. ;N:"RTA<IN=(
That I0 ____________________0 ilipino0 of le+al a+e0 ________________0 __________________
name ci)il status position
&f ____________________________0 after ha)in+ been dul7 s>orn to in accordance >ith la>0 do
name of compan7
hereb7 depose and sa7:
1. That our compan7 shall abide b7 all applicable la>s and re+ulations of the
:epartment of 5abor and "mplo7ment?
2. That the remittances to 2220 @:.0 Philhealth0 "$$ and BIR >ill be paid reli+iousl7
b7 the compan7.
In >itness >hereof0 I ha)e hereunto a1!ed m7 si+nature this __ da7 of ________ 24__ in
____________________________________

_______________________________
6A1antAs Name 92i+nature8
2;B2$RIB": AN: 2,&RN to before me this ___da7 of ________244/. A1ant e!hibited to
me his9her Residence $ertiBcate No. ____________0 issued at _________ on ___________.
:oc. No. __________
Pa+e No. __________
Boo- No. __________
2eries of __________
Note: All contracts entered into after this registration shall be reported to the DOLE Regional Ofce on
or before the 10
th
day of the month immediately following the date of entry into contract.
orm No. 1
Instructions in Accomplishin+ orm No. 1
APPLICATION FOR REGISTRATION OF JO CONTRACTOR!
S"CONTRACTOR
This form shall be accomplished b7 the contractor9subCcontractor in
triplicate and submitted to the :&5" Re+ional ield &1ce ha)in+ Durisdiction
on the place of the contractors9subCcontractorsA main o1ce.
). *#'ne## Name
"nter the business name of the contractor9subcontractor re+istered
>ith the 2"$0 :TI0 $:A0 or :&5".
+. *#'ne## Addre##
"nter the business address of the contractor9subCcontractor
,. Telep-one No.
"nter the telephone number6s8 of the contractor9subCcontractor.
.. Conta%t Per#on!Po#'t'on
"nter the name of the President or =eneral .ana+er or an7 other
o1cer of the compan7 >ho can pro)ide information on the entries.
Indicate the position of the o1cer.
/. Area# of Operat'on
"nter or enumerate the area6s8 or places co)ered b7 the contractor9
subcontractor.
0. Nat*re of *#'ne##
Indicate the -ind of business the contractor9subCcontractor is en+a+ed
in i.e.0 Danitorial ser)ices0 messen+erial0 truc-in+ ser)ices0 etc.
1. Ind*#tr'e# to be %o2ered
Indicate the -ind of industries of the clients9prospecti)e clients to be
co)ered.
3. N*mber of Re4*lar 5or6er#!7ale!Female
"nter the number of re+ular >or-ers of the contractor9subCcontractor
bro-en do>n into male and female.
8. Name#9 Po#'t'on#9 and Addre## of O$%er#!Sta&
"numerate the names of the o1cers and sta3 of contractors9subC
contractor0 their respecti)e positions in the compan7 and their
respecti)e home addresses. This does not include the names of the
>or-ers to >or- >ith the principal. Additional sheet ma7 be used if
necessar7.
):. L'#t of A%t*al Cl'ent#
"numerate the name6s8 and addresses of the clients >ith >hich the
contractor9subCcontractor ha)e e!istin+ contracts0 its nature of
business0 ser)ices to be pro)ided to the client0 number of personnel
assi+ned to each client0 description of each phase of the contract0 the
number of emplo7ees co)ered in each phase of the contract0
disa++re+ated into male and female.
)). "nderta6'n4
Indicate the needed information in the blan- spaces pro)ided in the
underta-in+.
The si+nature of the President or =eneral .ana+er and the date
of si+nin+ should appear in the desi+nated portion of the form.