PHILIPPINE BUSINESS REGISTRY SOLE PROPRIETORSHIP NEW APPLICATION FORM. T Dri Registration Type Tew buses Nae (Please select one TWh Gsng OTT Cant Nomber Tore hgendies Raginraton Pease chack what employer numbers you want to get) sss Grhikeath Arapsaic usness Name Scope (Pease check one ‘Total Fees once #15 OD documentry samp tae ‘Darangay (6200.00) Ciny/Muniipalty (8500.00) [reg onal 8,000.00) National (2,000.00) sine | Dtaraneny Dicayimniialn regional BUSNESSDETATS Towsauldng No 8 aulng Townl ry Mabie No, i Fanned No of tmployees OWNERS DETATS Tile Name Trees WA tno mile Name) ry eg iast ui) others Wan Name liniate NA # mothers Test hae at Name TN i 96 Tn N/A swe sctionF single egaly Separated Widowed Gi Satur 5 Se varies [OMsle — Oremale 15 Ciena eka address Tews aang Wo anf Phone Ne {Passe putin ees cose} 75 (Pleve check all that apis ‘iinutaetre Producer wholes Tsenice importer cate Main Business Activity (Select one aon Re business actives you chase above) ‘Gianutectre Producer Gwrolesier sevice Dimporter Tndieate Man Preduet Hand SeiceRendeeaTTIW ISSUANCE (without TA Contact Person /arereded Tox agent rot te owner] i tas name Fe Personal — LsingleWidawed/Lagaly Separated (No dependent Bxemption | Usingle/Widowed/ogalySepareted (With dependent Givarig,indetef husband orf clamsadstionl exertion Spouse Spouse PmpiorerE pone SE Aiona exer ptors [us down numberof dopendere UNDERTAKING Ber Department Administrative Order {9AO} No 10-01 as amended, hereby declare that 1. Allaformation supple inthis application are rue and correct to thebestof my belie and knowledge; 2. Any fale or misleading information supplied, or aoduction of material ale or misleading document to support the application Shall bea ground fo the appropriate criminal, ci and a administrative action against me 5. I shal voluntary cancel or change the registered business name in he event anoter person, fm or entity reports to DT that she/he a prorregetrant nd awful use ofan identical or confusingly slr business name, {am ful aware of and stall strictly comply withthe aovsion of Act No, 3883, 35 amended, and Is implementing cules and regulations nd oter relate awe and roles; ad 5 fis my responsi to ensure that my propose business names not and wil not be use for business that sila, offensive, scandalous, or contrary to propriety (Pop's lueteng Betting Station, Boobs Masta & Spa}: bJnot the sare or neatly te same a n exiting easteres busines, company, partnership, corporation, cooperative name nar it infringes on any trademark, service markanc tradename (Anne Ook slechon, Jobe tarbax Cafe, )not composes purey of generic or georaphie words [The Drugstore, Sacoleds} “nat name which by law or regulation cannot be appropriated (OTOP, ineligence, State Coleg not used to designate or estinguish, or suggestive of quay of any clas of goods, artes, merchandise, or sevice (Best TahoFactory, 2 Auto Repair Shop f) not used by the gavermant in is governmental functions (NB vate Investigation Serves, OI Trading); }not a name or abbreviation of name of any nation, inter governmental or itarationalarganation Pooling Agency, UNESCO Marketing, WHO Health Services); and iis nt dceptve, misleading or which misrepresent the nature of busines; and ("GOLD Construction Services” where nature of Tusiness is veeutment) llppine Mangower Aoplcan?s Sanatare Over Printed Name Date For DTiUse Fee: Rec'd by: Only TAN/ PAN |Date Registered | BN Certificate No. ‘Office [OR Number: | Date Paik IIR Tax identification No. [585 Employer No. PhilHealth Employer No. PAG-IBIG Employer No.(GENERAL INSTRUCTIONS IN ACCOMPLISHING AND SUBMITTING AF CATION AND REQUIREMENTS ‘= Accomplish the application form by typina/printing (upper case/capital letter); completely and clearly All required fields/information are printed in itales. For online application form, these are marked with red asterisk (*) + Do not abbreviate the information, in business name, business and owner's address and name of ‘owner in the Certficate of Business Name Registration, + Only the owner ofthe business is authorized to sign the application form. + Present 1 vali ID together with the application form to the proper OT! Office, where the business Is located, Registration Checklist 1, DT1 Registration Type. Tick the appropriate button for your business. If With Existing DTI Certificate ‘Number, indicate the Date of Registration and previous Certificate Number. 2. Core Agencies Reaistration. Tick the appropriate button of the agencies where you want to register Proposed Business Name 3. Business Scope. Tick the appropriate button of the scope of your proposed business. Business scope refers to the business location and NOT on where the business shall operate 4, Business Location, Indicate the specific location of your business based on your business scope. 5. Proposed Business Name. Business Name (BN) should be reflective of the nature of business and must have prefix, infix, and/or suffix (e.g, Alberto’s Garment Manufacturing, Marita’sCarinderia). Use of dominant or generic (e.g. Automotive Enterprise, you must add a prefix) business names are not allowed. Business Details 6. House/Bullding No. Includes building name and floor number, Lot, Block and Phase numbers, and Subdivision name, among others. 7. Street, 8. Barangay and 9. Town/City , 10. Province., and 11. Region. Exact address of your business based on the business location 12 Phone Number. 13. Mobile Number. doth landline and mobile numbers with area code are required by PBR participating agencies. Required information for online applications only. 14, No. of Employees. Indicate number of employees, male/female employees, Owner's Details 15, First Name, 16. Middle Nome, 17.Lost Nome, 18Sutfix if applicable). Indicate correct entries as these ‘would appear in the Certificate of BN Registration, 19, Mother's Maiden Nome.Only First anc Last Nomes are required. Indicate N/A if mother is unknown. 22, Personal SSS, No. Individual’s SSS number. This is diferent from the business SSS number. 21.Position/Ttle. Default to Owner. Otherwise, cross out Owner and indicate position/tite in the business being registered, 22, Tax identification Number (TIN). A required information to be able to transact with any government office per E.0. 98. This shall be the basis of your Philippine Business Number (PBN), 23. Date of Binh. Owner must be of majority age at east 18 years old) 24, Ciuil Status. Tck the appropriate button. 25, Sex.Tick the appropriate button. 26. Citizenship. Owner must be a Filipino Citizen. Proof of citizenship (photocopy) such as PRC ID, voter's ID, passport is required. For Naturalized Filipinos, 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). Filipino citizenship is Acquired by Election, submit photocopy of Afidavit of Election or ID Card issued (original to be presented for comparison) by BID. 27. E-mail Address, Ths is where PAR e-mail notifications regarding your registration will be sent, 28. House/Building No. This information includebuilding name and floor number, Lot, Phase and. Block hnumbers, and Subdivision, among others. This Information will be printed in the Certificate of 8N. Registration. 29, Street, 30. Barangay, 31.Town/City, 32 Province., and 33. Region. These information willbe printed in the Certificate of BN Registration, 34 & 35 Phone Numbers, Elther landline or mobile numbers with area code is required.E Psic 36. Business Activities, 37. Molo Business Activity Tick appropriate button, 38. Product/Service. Include applicable product/service as long as they are allied. Identify only one (1) main product/service F. TIN ISSUANCE 39, First Name,t0, Middle Nome, 41. Last Name, 42 Suffix (if applicable). Indicate name of representative if not owner is the contact person. 43, Phone Number. Indicate phone number of contact person. 44, Personal Exemption. Tick the appropriate button. 45, Spouse First Name,46, Spouse Middle Name, 47. Spouse Lost Name, Indicate name your spouse if married, 48, Spouse Employment Status. 49, Spouse TIN. 50, Spouse Employment TIN. 51. Spouse Employer's Name, indicate f you are married, ‘52, Additional Exemptions. Indicate i there is/are any. PLEASE CHECK E-MAIL NOTIFICATIONS FOR INSTRUCTIONS ON OR STATUS OF YOUR REGISTRATION WITH ‘THE VARIOUS AGENCIES.