DTI_BN Application Form for Sole Proprietor_Form No. 16A | Franchising | Identity Document

Republic of the Philippines Department of Trade and Industry BUSINESS NAME APPLICATION FORM FOR SOLE PROPRIETOR NEW

A. Business Details 1. Type of Business

BTRCP Form No. 16A 2008 Edition (Please read instruction/ requirements at the back before filling-up the application form)

RENEWAL

(PLEASE TICK THE APPROPRIATE BUTTON FOR REGISTRATION OF BUSINESS NAME UNDER ACT 3883, AS AMENDED) Main Branch _____________________ _______________________ (Indicate Date of Registration and Certificate No. of Main Office) Franchise/Dealership______________________________________ (Indicate Name of Franchisor/Dealer) st 1 nd 3. Proposed Business Name(s) 2 (in order of priority) rd 3 4. Tax Identification Number B. Business Address and Phone Numbers 6. House/Building No. 7. Street 10. Province 11. Zip Code 5. E-mail Address 8. Barangay 9. Town/City Yes No 2. For Renewal Only Previous Certificate No. ___________ Date of Registration ___________

12. Phone Numbers Landline ____________ Mobile ____________ 14. I would like to receive /subscribe to simple messaging service (SMS) notification and I understand that applicable fee will be deducted from my mobile credit per SMS I receive or send. Yes No C. Employee Count and Capitalization 15. No. of Employees _____ Male _____ Female D. Owner s Details 17. First Name _____ With Disability _____ With Disability 18. Middle Name

13. Are you the original owner of the business? If No, acquired thru Transfer Assignment

Bulk Sales

Business Name _____________________________________ Certificate No. _____________________________________ Date of Registration ___________________________________ 16. Capitalization (in Philippine Peso) 19. Last Name 23. Date of Birth 20. Suffix (e.g. Jr, Sr, I, II) 24. Civil Status 25. Citizenship

21. Sex 22. Do you consider yourself as Person With Male Female Disability (PWD)? Yes No E. Owner s Address and Phone Numbers 26. House/Building No. 27. Street 30. Province 32. Phone Numbers Landline _______________ Mobile _______________ F. Business Activity(ies) and Product(s)/Service(s) 34. Business Activity Exporter Importer Wholesale Retailer Manufacturer/Producer Service UNDERTAKING 31. Zip Code

28. Barangay

29. Town/City

33. Have you ever been convicted of any crime involving moral turpitude? Yes No

35. Product Handled/Service Rendered

I hereby declare that all information supplied in this application are true and correct to the best of my belief and knowledge, and further declare that any false or misleading information supplied, or production of materially false or misleading document to support the application shall be a ground for the appropriate criminal, civil and or administrative action against me. Further, I hereby commit to abide by the following: 1. 2. 3. Change and/or cancel the registered business name in the event that there is already another person, firm or entity lawfully using an identical or confusingly similar name; Comply with the provisions of Act 3883, as amended and its implementing rules and regulations and other related laws and rules; and Recognize and accept the authority and power of the Department of Trade and Industry or any of its designated representatives or agents to check and monitor compliance to my business establishment with various trade and industry laws and its implementing rules and regulations, and violations of the same shall be likewise a ground for the cancellation of my Certificate of Business Name Registration.

_________________________________ ______________________________ (Signature Over Printed Name) Date -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------For DTI Use Only TRN/PBN Date of Registration Certificate No. Processed By Office OR Number Date Paid Approved Business Name

(2) Deed of Sale. Foreign Nationals are subject to Foreign Investment Act and must submit the following: (1) Certified True Copy (CTC) of the current year s Permit to Engage in Retail Business under R. 11. indicate BN. he had no creditors. Phone Numbers. Updates the subscriber the status of applications. Proof of citizenship (photocopy) such as PRC ID. for records purpose only. Town/City and 10.A. Indicate correct entries as these would appear in the Certificate of BN Registration. Phase and Block numbers. among others. Either landline or mobile numbers with area code. Proposed Business Name. Middle Name. Province. Certificate Number. Date of Birth.00 . (4) Original Certificate of Business Name Registration of Vendor for cancellation. Required information for online applications only. If Franchise or Dealership. Phone Numbers. Last Name. 4. No. D. Indicate if Married. (5) clearance from other involved agencies such as Department of Science and Technology.00 Surcharge for Renewal (beyond 90 days after expiration) . 18. these are marked with red asterisk (*). Only the owner of the business is authorized to sign the application form. etc. Block and Phase numbers. Civil Status. E. and Date of Registration of previous owner. of Employees. 35. Indicate a more realistic capitalization. Lot. 98. business and owner s address and name of owner in the Certificate of Business Name Registration.Php 15. 22. completely and clearly. indicate the Date of Registration and Certificate Number of main office. 1180 from the concerned Local Government Unit (Alien Retailer only). Town/City and 30. Check the Philippine Postal Service Web site for proper Zip Code 12. (2) Photocopy of Alien Certificate of Registration (ACR). (3) Inventory of properties sold. Owner s Details 17. 32. A corresponding fee will be deducted from your mobile credit per SMS received or sent. If business is acquired through Transfer. DTI advisory. Employee Count and Capitalization 15. 31. If Filipino citizenship is Acquired by Election. If Branch. 16. Indicate if applicable. Indicate Yes or No. A Consent Certificate in lieu of the Franchise/Dealership Agreement is required to be submitted.O. Assignment or Transfer. (3) Accomplished DTI Form No. C. Tick the appropriate button for your business. Check the Philippine Postal Service Web site for proper Zip Code. Business Activity. Automotive Enterprise. Capitalization. A required information for online applications only. infix . ADDITIONAL DOCUMENTS MAY BE REQUIRED ON A CASE TO CASE BASIS DEPENDING ON ACTUAL EXAMINATION AND PROCESSING OF THE APPLICATION. House/Building No. 17 under R. or Widowed. Alberto s Garment Manufacturing. Owner s Address and Phone Numbers 26. in business name. Conviction of any crime involving moral turpitude. 24. For Naturalized Filipinos. Either landline or mobile numbers with area code. 13. together with the application form to the proper DTI Office. 3.Php 100. Method of Acquisition. 21. Zip Code. Barangay and 9. Philippine National Police (PNP). Zip Code. you must add a prefix ) business names are not allowed. Assignment or Bulk Sales. male/female employees with disability. Owner must be a Filipino Citizen. Submit the following: (1)Affidavit of Vendor stating that at the time of sale.Php 300. House/Building No. Sex. among others. This information include building name and floor number. 7. Business Name (BN) should be reflective of the nature of business and must have prefix. voter s ID. 34. indicate Male or Female. Street. A. among others. submit photocopy of Affidavit of Election or ID Card issued (original to be presented for comparison) by BID. Product/Service. Use of dominant or generic (e. assigned or transferred.g.GENERAL INSTRUCTIONS IN ACCOMPLISHING AND SUBMITTING APPLICATION AND REQUIREMENTS Accomplish the application form by typing/printing (upper case/capital letter). and Subdivision. All required fields/information are printed in italics. Includes building name and floor number. Lot. For online application form. 19.00 Documentary Stamp Tax . Type of Business. and/or suffix (e. where the business is located. 20 Suffix (if applicable). Indicate number of employees.00 Php 55. Submit the following (where applicable). These information will be printed in the Certificate of BN Registration. Street. Indicate the previous Certificate Number and Date of Registration. 8. This information will be printed in the Certificate of BN Registration. Barangay. Single. 29. These information will be printed in the Certificate of BN Registration. 7042. First Name. submit photocopies of Naturalization Certificate and Oath of Allegiance or ID card (original to be presented for comparison) issued by the Bureau of Immigration and Deportation (BID). Include applicable business activities and identify only one (1) main activity. These information will be printed in the Certificate of BN Registration. Tax Identification Numbe (TIN). APPLICABLE FEES BN Application Fee (New/Renewal) Bulk Sales . A required information to be able to transact with any government office per E. 2. 33. for statistics purposes. Include applicable product/service as long as they are allied. Citizenship.g. Person With Disability. Indicate in order of priority. 27. or if there are creditor(s) a copy of notice to them regarding the sale. E-mail Address. Business Details 1. Marita s Carinderia). and Subdivision name. Province. Required information for online applications only. Do not abbreviate the information. 5. (4) Current written appointment of Filipino resident agent. 14. 28. Owner must be of majority age (at least 18 years old) 25. passport is required. indicate the name of the Franchisor. 23. For Renewal Only. Identify only one (1) main product/service.A. Business Address and Phone Numbers 6. B. Subscription to simple messaging service (SMS).

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