APPLICATION FOR REGISTRATION UNDER THE

INVESTMENT CODE OF LUCENA CITY

Ordinance No. 2014, S-2001,
as amended by Ordinance No. 2672, S-2018

Application No. _______________

INFORMATION OF APPLICANT

Name of Company :
Office Address :
Plant/Farm Address :
Name of Authorized Representative :
Position :
Address :
Telephone Number : Fax Number
BUSINESS ORGANIZATION BUSINESS REGISTRATION
 Existing in Lucena City  New in Lucena City  None at present
 Single Proprietorship
 Partnership Registered with:
 Corporation
 Cooperative  SEC  DTI
 Others (pls. specify)  BOI  CDA
 Local  Others (pls. specify)
 Foreign

If Foreign, Percentage of Philippine equity sharing capital _______

PROJECT PROFILE

Investment Area :  Agri- Tourism or Tourism Oriented Enterprise

 Labor Generating Business Enterprise (at least 100)  Construction of Parking Lots/ parks beautification
 Property Development In Less Developed Areas  Others
 Manufacturing Enterprise

Please Specify/give general description of project:

___________________________________________________
___________________________________________________
Amount of Capitalization/
Additional Capitalization for existing enterprise:

Percentage of Employment of bona fide residents of Lucena City ____________________________________

Total Number of Employees ____________________________________

Estimated Breakdown Project Cost:

CERTIFICATION
This is to certify that the information reflected herein are true and correct to the best of my knowledge and that our company, as
represented by the undersigned authorized representative, has read and understood the Lucena Investment Incentive Code and the
rules and regulations implementing the same, and commits itself to abide by the provisions thereof:
Done this ___________ day of _____________________at __________________ Philippines.

____________________________
Signature over Printed Name
DO NOT FILL –UP BELOW:
SECRETARIAT’S ACCEPTANCE BOARD ACCEPTANCE
( ) ____________________________ ( ) ______________________________
SUBSCRIBED AND SWORN to before me this ________ day of __________________ after the affiant has exhibited
his/her Identification No. ___________________________, issued at _________________ on ___________________.

Doc No. ___________

Page No. __________
Book No. __________
Series No. _________
 P30,000,000.00 to P49,999,999.00
 P50,000,000.00 and above