Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office No. _________

APPLICATION FOR BOILER INSTALLATION

1. Name of Establishment:
2. Complete Business Address:
3. Owner/Manager and Address:
4. Where Boiler/Pressure Vessel is to be installed:
5. Plans to be submitted: submit (in quadruplicate) the foundation plan with design, installation and
location plans of the boiler. The plans shall be prepared, signed and sealed by a Professional
Mechanical Engineer. Plan shall also bear the name and signature of owner or manager of the
plant. The working drawing of the boiler shall be submitted together with the First Inspection
Report.
6. Boiler/Pressure Vessel Data:
a.

Manufacturer:

b.

Type:

c.

Serial Number:

d.

Place of Origin:

e.

Date of Make:

f.

Heating Surface:

g.

Max. A.W.P.:

h.

Horsepower:

7. Printed Name and Signature of Person to Supervise the Installation:

PME Registry No.

PTR No.

Date:
Date:

TIN:
8. Other accessories or equipment:

Printed Name and Signature of Owner/Manager

Company TIN:
Company Tel. No.

Application No.