FormNo.

03

DepartmentofTransportation&Communications
LANDTRANSPORATIONOFFICE
EastAvenue,QuezonCity

RENEWALAPPLICATIONFORACCREDITATIONOF
MANUFACTURER/ASSEMBLER/IMPORTER/REBUILDER/DEALER
OFMOTORVEHICLESAND/ORITSCOMPONENTS

DATE:_____________________

BUSINESSNAME:___________________________________________________________________

BUSINESSADDRESS:___________________________________________________________________

_____________________________________________________________________________________

CONTACTNO. :_________________________________

CLASSICATION: ManufacturerChassis
BodyOther___________
Assembler 4Wheels3Wheels2WheelsOther___________
ImporterBrandNewCBUUsedorsecondhandMV

UsedComponentsOther__________
Rebuilder TruckBusOther___________
DealerCarUVSUVBusTruck
TrailerMotorcycleComponent

Other___________

DOCUMENTARYREQUIREMENTS
GeneralRequirements

()OriginalLTOCertificateofAccreditation

()Latestcertifiedtruecopy/iesofMayorsPermitoftheestablishment/sintheplace/s
whereitisdoingbusiness

()DulynotarizedAffidavitattestingtoitscontinuingcompliancewithalltherequirements
foraccreditation.Stocksandsalesreporting,unlesstherearechangestheretoinwhich
casetheapplicantshallsubmittheapplicabledocuments.

_______________________________________

__________________________
PrintedName&SignatureofApplicantand/or

Designation
AuthorizedRepresentative

SUBSCRIBEDANDSWORNtobeforemethis___dayof_________________,affiantexhibitingtome
his/herResidenceCertificateNo._______________issuedat_______________on____________
Doc.No.______
PageNo.______

BookNo.______
Seriesof______

NOTARYPUBLIC