BLR Form No.

3, Series2016

Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. ____

APPLICATION FOR UNION REGISTRATION

(INDEPENDENT)
PART I. INFORMATION ABOUT THE REPORTING ORGANIZATION Date Accomplished (mm/dd/yyyy)
To be accomplished by the applicant. Supply all required information. Misrepresentation, false statement or fraud in this
application or any supporting document is a ground for denial or cancellation of registration.

Name of Applicant Organization Contact Nos.

E-mail: ________________________________
Address Landline No: ___________________________
Mobile No:_____________________________

Name of President Contact Nos.

(First Name) (M.I.) (Last Name)
E-mail: ________________________________
Landline No: ___________________________
Address
Mobile No:_____________________________

Gender Male Female

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Date Organized (mm/dd/yyyy) Date of CBL Ratification (mm/dd/yyyy)

Name of Establishment Industry Classification Coverage of the Bargaining Unit

(Pls. Refer to PSC in the TSSD) Supervisory
Super
Rank and File
Rank
Address If Educational Institution:
If SU
 Teaching

 Non-Teaching

No. of Employees in the Company No. of Employees in the Bargaining Unit No. of Union Members
Male Male Male
Female Female Female
TOTAL TOTAL TOTAL
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I attest to the truth of the foregoing.

________________________________________________
President
(Signature over printed name)

Subscribed and sworn to before me at ___________________________________________________, Philippines, this _______

day of _________________ 20 _______ with I.D. No. ________________________________________issued by
__________________________________________________ on _________________________________.

NOTARY PUBLIC

Doc. No. __________

Page No. __________
Book No. __________
Series of __________

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