TC Form 5 For TC use only

INFORMATION FOR THE CONDUCT OF TCI (SG) No.: ____________

Date : __________________
INVESTIGATION PURSUANT TO THE Records Officer : __________
SAFEGUARD MEASURES ACT (RA 8800)
(To be submitted in triplicate)

I. GENERAL INFORMATION

Please check one:

Petition by Domestic Industry for Extension of Measure
TC Monitoring of Developments in Domestic Industry
TC Evaluation of Effectiveness of Action Taken by the Domestic Industry

A. Petitioner/Domestic Manufacturer

1. Name of Company: ___________________________________

2. Name of President: ___________________________________

3. Contact Details:

a. Office

Contact Person: _______________________________

Position : _______________________________
Tel./Fax Nos.: _______________________________
Email Address: _______________________________
Address: _______________________________
_______________________________

b. Plant/Factory

Contact Person: _______________________________

Position : _______________________________
Tel./Fax Nos.: _______________________________
Email Address: _______________________________
Address: _______________________________
_______________________________

4. SEC Registration No.: _______________________________

Date Registered: _______________________________

5. BOI Registration No.: _______________________________

Date Registered: _______________________________

6. ISO Certification (type and no.): _________________________

Date Registered: _______________________________

Page 1 of 6 TC Form 5| Revised August 2016

 II. PRODUCT INFORMATION

A. Article(s) Produced Subject of Safeguard Action

Product(s) AHTN Code Rate of Duty (%)

III. RELEVANT ECONOMIC AND FINANCIAL DATA

Please supply data for each product covering the last three (3) years up to the most recent period
for which data are available. Use separate sheet if necessary.

A. Market Share (%)

Year Q1 Q2 Q3 Q4 Total

B. Rated Capacity, Actual Production and Capacity Utilization

Annual Rated Capacity Actual Production Capacity

Year (Volume) Volume Value Utilization
(unit of measure) (unit of measure) (PhP) (%)

C. Domestic and Export Sales

Domestic Export
Year Volume Value Volume Value Country of
(unit of measure) (PhP) (unit of measure) (PhP) Destination

Submit a separate sales report on your importation of subject article/s, if any,

Submit a separate sales report on your importation of subject article/s, if any, for re-export.

Page 2 of 6 TC Form 5| Revised August 2016

D. Inventory

1. Finished Goods

Beginning Inventory Ending Inventory

Year Volume Value Volume Value
(unit of measure) (PhP) (unit of measure) (PhP)

2. Major Raw Materials

Beginning Ending
Source Consumed
Inventory Inventory
Raw (Local
Year Volume Volume Volume
Material and/or Value Value Value
(unit of (unit of (unit of
Imported) (PhP) (PhP) (PhP)
measure) measure) measure)
(1)
(2)
(3)

E. Selling Prices

Domestic Selling Price Price of Imported Counterpart

Year
(PhP / unit of measure) (PhP / unit of measure)

Please submit information on distributor’s discounts / commission or any other data that affect the selling price
of the subject article.

F. Employment and Compensation Data

Employment (Number) Compensation (PhP)

Year Directly involved in Directly involved in
Total Total
production production

G. Audited Financial Statements (For the last three (3) years)

Please submit copies of audited financial statements including Notes to Financial Statements.
Submit also statements/schedules on cost of goods sold, depreciation/amortization; and long-term
liabilities.

If the company has multiple products, please prepare separate statements of income as well as
separate schedules specific to the subject article.

Page 3 of 6 TC Form 5| Revised August 2016

 H. Cost of Production (For the last three (3) years)

Please present separate costs for each product type. Use separate sheet if necessary.

Particulars Year 1 Year 2 Year 3

Product Type Type Average Type Type Average Type Type Average
Production Volume

Unit Cost of Production

(Peso/Unit)
Materials and Supplies:

(1)
(2)
(3)
Total Raw Materials
Direct Labor
Manufacturing Overhead:
Indirect Labor
Fuels:
Gasoline
Diesel
Bunker
Others 1/
Electricity
Water
Packaging
Depreciation
Rent
Others 1/
Total Manufacturing
Overhead
Total Unit Cost of
Production
Operating Expense 2/
Cost to Produce & Sell
1/ - Identify costs separately.
2/ - Identify each expense/cost separately. Separate handling and delivery expenses.

Page 4 of 6 TC Form 5| Revised August 2016

 IV. COMPLIANCE WITH ADJUSTMENT PLAN

A. In Adjustment Plan

Please list ALL the measures specified in your adjustment plan. If a measure was not
implemented, please provide an explanation. Moreover, please provide documentation to prove
that the specific measures were undertaken, the percentage of completion, and the positive effects
that were achieved.

Specific
Period of Percentage of Expenditure Positive
Measures Remarks
Implementation Completion (Php) Effects
Undertaken

B. New Measures

Please list additional measures that you undertook/intend to undertake as part of your adjustment
plan to import competition. For the specific measures that were undertaken, please provide
documentation to prove that the specific measures were undertaken, the percentage of completion,
and the positive effects that were achieved.

Specific
Period of Percentage of Expenditure Positive
Measures Remarks
Implementation Completion (Php) Effects
Undertaken

V. CERTIFICATION

I hereby certify that all information contained herein is true and correct and relate to the
subject article(s). I commit that any additional information required will be submitted within 10
working days after receipt of request from the Commission.

_________________________________
Petitioner’s Signature over Printed Name

Page 5 of 6 TC Form 5| Revised August 2016

 GENERAL INFORMATION AND INSTRUCTIONS
A. Steps in the Application for Extension of Measure Pursuant to Section 712 of the Customs
Modernization and Tariff Act (CMTA):

Unit/
Step Activities 1 Fees
Person-In-Charge
1 Proceed to Cashier for payment of P20,000.00 Cashier
investigation fee 2 (Filing Fee)

P200.00
(Legal Research Fund Fee)
2 Preliminary Conference 3 Presiding Officer
3 Submission of initial memoranda / Records Officer
position paper 4
4 Ocular inspection of plant facilities / Task Force
Verification of data 5
5 Public Hearing 6 Petitioner to pay Presiding Officer
publication cost 7
6 Submission of amended position Records Officer
paper / principal memoranda 8
7 Issuance of TC Report of Findings and Task Force /
Recommendations to Secretary of Records Officer /
Agriculture/Trade and Industry and Planning
Parties 9 Management and
Information
Systems Division
1 Investigative Timetable: 120 calendar days from receipt of the referral of the Secretary /
60 calendar days if certified urgent by the Secretary
2 Parties will be informed of initiation of TC formal investigation; Processing time: 30 minutes
3 Parties will be informed of schedule of preliminary conference
4 Parties will be informed of deadline for submission of position papers
5 Parties will be informed of schedule of ocular inspection/data verification
6 Parties will be informed of schedule of public hearing
7 Notice of billing will be sent to parties
8 Parties will be informed of deadline for submission of documents
9 Check status of investigation on TC website: www.tariffcommission.gov.ph

B. Required attachments upon submission of TC Form 5:

1. Audited Financial Statements

2. Statements of Income specific to subject article
3. Schedule on Cost of Goods Sold, Depreciation/Amortization, and Long-Term Liabilities

C. Information deemed confidential should be so marked.

D. Notes:

● The Tariff Commission reserves the right to request additional information deemed
necessary in the review.

● Information submitted is subject to verification.

● For any clarification, please call the Office of the Director, Research, Investigation
and International Trade Analysis Service (RIITAS) at telephone numbers: 433-58-98/
926-74-76.

Page 6 of 6 TC Form 5| Revised August 2016