APPLICATION FOR THE REGISTRATION OF A FIRM NAME OR BUSINESS

NAME OR STYLE UNDER ACT NO. 3883, AS AMENDED BY ACT NO. 4147
AND BY R.A. NO. 863

The Director of Commerce

Manila

Sir:

Pursuant to the provisions of Act 3883, as amended by Act 4147 and by R.A. 863,
I hereby apply for the registration of the following firm name or business name of style:

__________________________________________________

to be kept exhibited by me on a signboard, in plain view of the public, in or at the place

where my business is conducted. I am enclosing herewith the sum of TEN PESOS
(P10.00) as registration fee and thirty centavos documentary stamp to be affixed to the
certificate. I hereby certify under oath that the answers to the following questions are
true and correct:

1. Name of Owner ____________ Age ________ Nationality _______________

2. Residence ______________________ Name of Manager ________________

3. Capital invested: P _____________; if partnership, state the amount

contributed by each partner.

Name of Partner Contributed Nationality Address

______________ __________ _______________ ____________________
______________ __________ _______________ ____________________
______________ __________ _______________ ____________________

If owner is a juridical person, state whether (a) it is a corporation of partnership; (b)

registration number and date of registration; and (c) office where registered.

_______________________________________________________________________
_______________________________________________________________________

4. Description of business for which the firm or business applied for

_______________________________________________________________________

5. Is the business already in operation? __________________________________

6. Location or place of business: _______________________________________

 7. Who was the former owner of this business, if any? _____________________

8. When did you actually begin using this business name? ___________________

9. Have you secured the necessary permit and license on the establishment for
which the business name shall be used? ______________________________________

10. Permit granted by ___________ Nc. ____________ Date _____________

Municipal License No. ________________________ Date _____________
Internal Revenue License No. __________________ Date _____________

11. If foreigner, Alien Registration No. ______________ Date _____________

Very respectfully,

________________________
(Applicant)

Subscribed and sworn to before me this ________ day of __________ 200__, at

_________________, Philippines, by affiant who exhibited to me his Community Tax
Certificate No. ______________ issued at _______________ on ____________, 200__.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 200__.