Republic of the Philippines

CITY OF TARLAC
Tarlac
CITY ECONOMIC ENTERPRISE MANAGEMENT OFFICE
PLEASE PASTE
2X2 PICTURE
HERE

REGISTRATION FORM
(Please accomplish this form in printed legible handwriting.)

PERSONAL PROFILE:
Name of Applicant:

FAMILY NAME

FIRST NAME

FULL MIDDLE NAME

BLK./ZONE/SITIO/SUBD.

BARANGAY

Complete Residential Address:

HOUSE NO./STREET
Date of Birth:

Place of Birth:

MM/DD/YYYY
Sex:

Civil Status:

Age:

MUNICIPALITY/CITY/PROVINCE
Nationality:

FEMALE/MALE SINGLE/MARRIED/WIDOW *Filipino/s only

IN YEARS

Voters ID No./
Certificate No.

No. of Years as
Resident in Tarlac City

*Attach copy of the IDs/Certificate/s or Proof/s

BUSINESS PROFILE:
Intended Nature of Business:
Intended Location: (Make a complete diagram, and should conform to size as per guidelines issued by CEEMO.)
Location Mapped By:
_____________________
CEEMO Personnel
Location Approved By:
_____________________
CEEMO Head

Intended Manner of Exhibiting/Displaying Goods: (Check option.)

OPTION 1: Table Only

OPTION 2: Stand Only

Specifications: (In Meters)

LENGTH

WIDTH

Complete Name of Helpers and Relation to Applicant (Maximum of Two (2) Only):
1.
2.
I hereby certify that the abovementioned facts are true and correct to the best of my ability.

Signature Over Printed Name