10/11/2019 MTRCB DEPUTY FORM

A. REPORT INFORMATION

Name of Deputy *

First Name Middle Name Last Name

Deputy ID No. *

Email Address *

B. REPORT FOR FILM / MOVIE

Name of Theater / Cinema

Title of Film / Movie

DATE & TIME OF SCREENING

- - at :
Hour Minutes
Month Day Year

Classification Rating of Movie / Film

G PG R-13

R-16 R-18

Checklist for Film / Movie

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Permit to Exhibit is posted at a conspicuous place at the ticket booth.

YES NO N/A

A 4’x3’standee prominently displays the film classification rating at the entrance lobby of
the theater.
YES NO N/A

Theater owner/theater porter or attendant accepts only movie patrons within the age bracket
of the film classification rating.
YES NO N/A

All posters and photos displayed At the theater lobby is General Patronage and is safe for
all to see.
YES NO N/A

Other Comments

C. REPORT FOR TELEVISION PROGRAMS

Name of Television Network

Name of Television Program

DATE & TIME THE PROGRAM WAS SHOWED

- - at :
Hour Minutes
Month Day Year

Classification Rating of the Program

G PG SPG

Other Comments

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10/11/2019 MTRCB DEPUTY FORM

C. REPORT FOR PUBLIC UTILITY VEHICLES / SEA VESSELS

Name of Transport Company

Plate Number or Body Number

Route of PUVs/Passenger Vessel

Date & Time On Board

- - at :
Hour Minutes
Month Day Year

Other Comments

Verify that you're human *

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