TSA-7 Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT

Regional Office

APPLICATION FOR BOILER FABRICATION

1. Name of Manufacturer:
2. Complete Business address:
3. Manufactured for:

(Name of Establishment and Address)

4. Where Boiler is to be installed:

5. Boiler Data:
a. Type :
b. Kind :
c. Heating Surface : sq m.
d. Maximum A.W.P. : Kg./sq cm.
e. Horse Power :

f. Printed Name and Signature of Person

To Supervise the Fabrication:
PME Registry No. Date:
PTR No. Date:
TIN.
g. Additional Data
a. Manufacturer’s Data Report (4 copies)
b. Detailed Construction Drawings (4 copies)

Printed Name and Signature of Manufacturer

Company TIN:
Company Tel. No.:

Application No.
Plan fee: Inspection fee:
Total fee:
O.R. No. Date: