APPLICATION FOR ACCREDITATION & REGISTRATION

(CORPORATION-PARTNERSHIP-COOPERATIVE-RENEWAL)

_______________________
(Date)

Chief, Interim Customs Accreditation & Registration (ICARE) Unit

Intelligence Group

I, ___________________________________________, of legal age, with

postal address at _____________________________________________________
after having been duly sworn in accordance with law, hereby depose and say:

1. That I am the _________________________________________________of

_________________________________________ duly authorized to file this
application for renewal of accreditation and registration with the Bureau of
Customs, as evidenced by the attached written authority from the
company.

2. That I hereby present the following information for accreditation with the
Bureau of Customs

2.1. Name of the Firm __________________________________________

a. Head Office Address _______________________________________
____________________________________________
Year/s of Stay in the premises: _______________________________
Nature of occupation: ( ) owned ( ) leased ( ) shared ( ) others
Proof of Lawful Occupation: ( ) Certificate of Title
( ) Contract of Lease
( ) Usufruct Agreement
( ) Others, specify _____________
b. Warehouse Address ________________________________________
Year/s of Stay in the premises: ________________________________
Nature of occupation: ( ) owned ( ) leased ( ) shared ( ) others
Proof of Lawful Occupation: ( ) Certificate of Title
( ) Contract of Lease
( ) Usufruct Agreement
( ) Others, specify _____________
c. Branch Office ______________________________________________
d. Year/s of Stay in the premises: ________________________________
Nature of occupation: ( ) owned ( ) leased ( ) shared ( ) others
e. Telephone Number/s ________________________________________
f. Facsimile Number/s _________________________________________
g. *Email Address ____________________________________________
h. Company TIN _____________________________________________

*Mandatory Field since Notice of Denial/Approval will be send via

Email
2.2. Person managing the affairs of the firm:
Name: __________________________________________
Designation: __________________________________________
Telephone Number: __________________________________________
Specimen Signature: __________________________________________
2.3. List of Officers/Directors (For corporations and partnerships, please attach the
Latest General Information Sheet duly received by SEC)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

3. That I hereby attach herewith the following documents:

( ) BCOR evidencing payment of registration fee

( ) Printed Copy of CPRS Application
( ) Previous Accreditation Certificate
( ) Authorization of the Applicant
( ) Board Resolution
( ) Secretarys Certificate
( ) Others, specify
( ) Latest General Information Sheet
( ) Affidavit of No Change/Change of Cirsumstance/s (in case of any material
Changes in the circumstances of the company, documents in support thereof
must be presented)
( ) Current Mayors Permit as Importer with Official Receipt (duly certified by the
issuing agency)
( ) Current Barangay Clearance (duly certified by the issuing agency)
( ) Income Tax Return for the past 3 years, if applicable (Duly Certified by the
Issuing Agency)
( ) Value Added Tax Returns for the past 3 years, if applicable (Duly Certified
Issuing Agency)
( ) Valid Government Issued I.D. with Photo
( ) Community Tax Certificate Company
( ) Proof of Ownership of Business Premises
( ) Certificate of Title
( ) Lease Contract
( ) Others: ________________________

4.Other information:

1. Nature of Business (Use separate sheet of necessary)

Main Line of Business: ___________________________________
Secondary Line of Business ___________________________________
Other Business Activities ___________________________________

2. Summary of Previous Importation (Use separate sheet if necessary)

Commodity Volume (one year period)

_________________________ _____________________________
_________________________ _____________________________
_________________________ _____________________________

3. Capitalization _________________________________________

( ) Treasurers Affidavit
( ) Bank Certification
( ) Audited Financial Statement
( ) GIS indicating Paid-Up Capital of the Company
( ) Others, specify __________________________

4. Interest in other business/enterprise (if any)

Name of Firm Nature of Interest SEC/DTI Reg. No.

_________________ _________________ ________________
_________________ _________________ ________________
_________________ _________________ ________________
_________________ _________________ ________________

I hereby certify under oath that all the above information are true and correct;
all documents submitted in support of this application are true copies of the original,
subject for verification; any misrepresentation and/or manifestation of fraud in this
application shall be a ground for the disapproval of my application, and backlisting of
our firm and the undersigned as the applicant.

Very truly yours,

APPLICANTS NAME
By:

___________________________________
T.I.N. __________________________

SUBSCRIBED AND SWORN to before me this ___________ day of

____________________ in Manila, Philippines, affiant exhibiting to me his/her 2
valid government issued IDs: 1. _______________ issued at ________________ on
_________________, 2. ___________________ issued at
_______________________ on _______________________________.

NOTARY PUBLIC

Doc No. _____________

Page No. ____________
Book No. ____________
Series of ____________