ERD.1.F.

003
Revision 03. 04 September 2017
PART I
APPLICATION FOR REGISTRATION AS
ECOZONE LOGISTICS SERVICE ENTERPRISE

__________________________
Date

BGen CHARITO B. PLAZA MNSA, PhD

Director General
Philippine Economic Zone Authority

Madam:

In accordance with Chapter II, Section 12 (c) of Republic Act 7916, otherwise
known as the Special Economic Zone Act of 1995, as amended by Republic Act
its Implementing
8748, and Rules and Regulations, I am applying for the registration of

(name of company)
as Ecozone Logistics Service Enterprise for the
establishment/installation of ______________________
(Nature of Project)

to be located at
(Name and location of Ecozone)

The undersigned attest that the documents/information submitted are true and are
correct and that I assume full responsibility for any misrepresentation and/or
violation thereof.

Attached hereto are:

1. Project Brief;
2. Notarized application, undertaking, and Anti-Graft Certificate;
3. Board Resolution authorizing the filing of the application with PEZA and
designation of a representative(s) authorized to transact registration with
PEZA;
4. Certificate of Registration from the Securities and Exchange Commission and Articles
of Incorporation;
5. Resume or biodata of principal officers;
6. Audited Financial Statements for the last three (3) years (if operating);
7. Reservation form or similar document on building to be leased (if applicable);
8. Favorable endorsement from the developer/operator

Very truly yours,

 President/General Manager

ERD.1.F.003
Revision 03. 04 September 2017
PART II
PHILIPPINE ECONOMIC ZONE AUTHORITY
Building 5, DOE-PNOC Complex, Energy Center Rizal Drive, BGC, Taguig City

APPLICATION FOR REGISTRATION AS

ECOZONE LOGISTICS SERVICE ENTERPRISE

Date Filed
O.R. No.
Amount Paid

Applicant

Name of Firm
Address

Telephone No. Fax No.

E-mail Address Website

Applicant's designated Representative (s) to PEZA

Name Name
Address Address

Tel. No. Tel. No.

Fax No. Fax No.

Type of Application (Please Check)

New Ecozone Logistics Service Enterprise

Expansion/Additional Project
Amendment of Registered Activity

Site of Operation

Area Location
(Lot No. Block No. Phase etc.)
Name of Ecozone

Proposed Activity/ies
 ERD.1.F.003
Revision 03. 04 September 2017
Project Brief

I. Management Profile

1. Name of Company

2. Business Registration
Office Date Registration No.

Securities and Exchange Commission

Board of Investments
Others, please specify

3. Applicant's Parent Company or Management Company (if any)

Name
Address
Telephone No. Fax No.

4. Capital Structure
Amount Percentage Share
Authorized Capital
Subscribed Capital
Paid-up Capital
TOTAL

5. Major Stockholders (current)

Stockholder Nationality No. of Shares Amount Amount
Subscribed Paid-up

(use separate sheets if necessary)

6. Principal Officers (current)

Name Position Nationality

7. Manpower Requirement

Year 1 2 3 Average
Number of Manpower

8. Timetable of Project Implementation

Period
i.) Building construction/Improvement
ii.) Importation of machinery/equipment
iii.) Installation of machinery/equipment
iv.) Hiring/Training of Personnel
v.) Start of Commercial Operations
 ERD.1.F.003
Revision 03. 04 September 2017

II. Technical Aspect

1. Project Description

a. Describe in detail what scheme(s) or warehousing services the applicant proposed to undertake in the zone, and
the goods to be handled in accordance with Board Resolution (B.R.) No. 97-366, as amended by B.R. No. 01-210,
the guidelines for registration and operation of Ecozone Facilities Enterprise engaged in warehousing operations.

b. Provide brochures, listing of goods to be handled under warehousing operations.

2. Operational Flowchart / Services Flow

(use separate sheets if necessary)

3. Machinery and Equipment (List, Sources and Cost)

Machinery and Equipment Source Unit Cost per Amount

Unit

(use separate sheets if necessary)

4. Waste Disposal System

(use separate sheets if necessary)

III. Market Aspect

1. Target Market

2. Selling Price (per product)

3. Projected Revenues
Year Revenues (US$)
1
2
3
 ERD.1.F.003
Revision 03. 04 September 2017 2016

IV. Financial Aspect

1. Estimated Project Cost

Amount
Site Development ______________________________________________
Building Construction/Improvement
Machinery Equipment, and Office Equipment
Pre-Operating Administrative Expenses
Working Capital
Other Costs

Total Cost

2. Sources of Funds (Note: Total amount should at least be equal to total project cost for one year)

Amount
Equity
Loans
Other sources

Total
ECOZONE LOGISTICS SERVICE ENTERPRISE

APPLICANT'S UNDERTAKINGS

In applying for PEZA registration, the Applicant herewith makes the following representations and commitments:

1 . That the applicant is capable of operating, on a sound and efficient basis, and of contributing to the
objectives of the Philippine Economic Zone Authority in particular and to the development of the national
economy in general;
2 . That the project is economically, technically and financially sound;
3 . That the applicant proposes to engage, in good faith, in the creation of a market for its project/product;
4 . That the applicant has installed/undertakes to install an accounting system adequate to identify the
investments, revenues, costs and profits or losses of the project covered by this application separately
from the aggregate investments, revenues, costs and profits or losses of the other business activities of
the applicant not registered under Republic Act No. 7916, as amended by Republic Act 8748 or has
established/undertakes to establish a separate entity for the project/activities covered by this application
if so required by the Authority. (Applicable only if applicant is engaged or proposes to engage in
undertaking or activities in addition to the project covered by this application);

5 . That the applicant shall submit periodic reports and other information, pertaining to its activities in the
Ecozone that the Authority may require;
6 . That the applicant has read Republic Act No. 7916, as amended, and the Rules and Regulations
adopted by the PEZA and commits itself to abide by the provisions thereof as well as amendments
thereto;
7 . The applicant will start and operate the project covered by this application within such reasonable time as
may be fixed by the Authority;
8 . That the applicant's Board of Directors has authorized the filing of this application in accordance with the
terms thereof if the applicant is a corporation;
9 . That pursuant to Section 2(p), Rule I of the PEZA Rules, the applicant's income derived within the
ecozone shall be subject to taxes under the National Internal revenue Code pursuant to Section 25 of the
Act;
10 . That no Board member or officer of the Philippine Economic Zone Authority has an investment or any
other financial interest, direct or indirect, in the applicant's enterprise; and
11 . That there exists no dummy relationship between any of the stockholders and/or principal officers of the
applicant and any foreign individuals/business entity.

Done in the City/Province of

this day of , 20 .

Affiant

Designation
Republic of the Philippines )
S.S.
City / Province of )

Subscribed and sworn to before me this_________ day of ________________ , 20___ in the City/
Province of ______________________. Affiant exhibited to me his Resident Tax Certificate No. _____________
issued at ___________________________ on _______________, 20___

Notary Public
Until December 31, 20_____
Doc. No.
Page No.
Book No.
Series of 20 6
 ERD.1.F.003
Revision 03. 04 September 2017
PART IV
ECOZONE LOGISTICS SERVICE ENTERPRISE

ANTI-GRAFT CERTIFICATE

I, , of legal age, President/General Manager

of with postal address at
after
having been duly sworn, depose and say:

That pursuant to the provisions of Section 3 and 14 of Republic Act 3019 (Anti-Graft Act), the
applicant enterprise, has not
given or promised to give, and will not give, any gift to any officer employee of the PEZA in connection wth the
filing and processing of this application, nor it will give such gift to any of said officers or employees after approval
of its application.

That based on the records of the applicant, no Board Member or Officer of the Philippine Economic Zone
Authority has an investment or other financial interest, direct or indirect, in the applicant; and

That this certificate was made with the approval of applicant's Board of Directors.

Affiant

Subscribed and sworn to before me this day of , 20

in the City / Province of . Affiant exhibited to me his Residence Tax
Certificate No. A. issued at
on , 20 .

Notary Public
Until December 31, 20_____

Doc. No.
Page No.
Book No.
Series of 20

7
 ERD.1.F.003
Revision 03. 04 September 2017
PART V
NAME OF APPLICANT:

APPLICANT'S UNDERTAKINGS
(For New Ecozone Logistics Service Enterprise only)

In applying for PEZA registration, the Applicant herewith makes the following representations and commitments:

1. That the applicant is capable of operating, on a sound and efficient basis, and of contributing to the
objectives of the Philippine Economic Zone Authority in particular and to the development of the national
economy in general;
2. That the project is economically, technically and financially sound;
3. That the applicant proposes to engage, in good faith, in the creation of a market for its project/product;
4. That the applicant has installed/undertakes to install an accounting system adequate to identify the
investments, revenues, costs and profits or losses of the project covered by this application separately
from the aggregate investments, revenues, costs and profits or losses of the other business activities of
the applicant not registered under Republic Act No. 7916, as amended by Republic Act 8748 or has
established/undertakes to establish a separate entity for the project/activities covered by this application
if so required by the Authority. (Applicable only if applicant is engaged or proposes to engage in
undertaking or activities in addition to the project covered by this application);

5. The exported products/services meet the standards of quality established by the Bureau of Standards or
in default thereof, by the Philippine Economic Zone Authority, or by such public organization, Chamber,
group or body as the Authority may designate.

6. Domestic raw materials and supplies will be used in preference to imported goods whenever these are
available at comparable quality and price.
7. That the applicant shall submit periodic reports and other information, pertaining to its activities in the
Ecozone that the Authority may require;
8. That the applicant has read Republic Act No. 7916, as amended, and the Rules and Regulations
adopted by the PEZA and commits itself to abide by the provisions thereof as well as amendments
thereto;
9. The applicant will start and operate the project covered by this application within such reasonable time as
may be fixed by the Authority;
10 . That the applicant's Board of Directors has authorized the filing of this application in accordance with the
terms thereof if the applicant is a corporation;
11 . That applicant has neither opened nor cause to be opened a letter of credit or entered into a contract for
the importation of capital equipment for which tax exemption will be claimed, prior to its registration with
the Authority. (Approval of the project brief containing a list of capital equipment proposed to be imported
does not amount to an implied approval of the tax-free importation of said capital equipment; a separate
application for this importation should be submittedfor PEZA approval.)

12 . Applicant shall comply with all rules and regulations on exportation of Philippine products/services
promulgated by the Central Bank, Department of Finance, Bureau of Customs and other government
agencies.

13 . Pursuant to the provisions of Sec. 3 and Sec. 14 of R.A. 3019 (Anti-Graft Act), the applicant-enterprise
has not given or promised to give and will not give any gift to any officer or employee of the Philippine
Economic Zone Authority in connection with the filing and processing of this application.

14 . The applicant's Board of Directors has authorized the release of the portion of its project study entitled
"Brief Description of the Project" to the public.
15 . That based on the records of the applicant, no Board member or officer of the Philippine Economic Zone
Authority has an investment or any other financial interest, direct or indirect, in the applicant's enterprise;
and
 ERD.1.F.003
Revision 01. 22 February 2016
PART V
NAME OF APPLICANT:

16 . That there exists no dummy relationship between any of the stockholders and/or principal officers of the
applicant and any foreign individuals/business entity.

Done in the City/Province of

this day of , 20 .

Affiant

Designation

Republic of the Philippines ) S.S.

City / Province of )

Subscribed and sworn to before me this_________ day of ________________ , 20___ in the City/
Province of ______________________. Affiant exhibited to me his Resident Tax Certificate No. _____________
issued at ___________________________ on _______________, 20___

Notary Public
Until December 31, 20_____
Doc. No.
Page No.
Book No.
Series of 20______