Republic of the Philippines

City of Pasay
Work Permit and License Application
PHOTO
TRANSACTION NO. ___________________________
NEW _________ Date: ___________
RENEWAL _________
MAYOR’S PERMIT NO. ___________________________

Please Print ________________________________________________________________________________________

Last Name First Name M.I.
____________________________________________________ ________________
Address Gender
___________________________ ___________________________ ________________
Date of Birth Place of Birth Telephone No.

Position Applied for: _____________________________________

Company Name: _____________________________________
Address: _____________________________________

Requirements Presented:

Police Clearance Control No.: ____________________ Date: ____________________

Health Cert. Registration No.: ____________________ Date: ____________________
Mayor’s Permit OR No.: ____________________ Date: ____________________

TIN ___________________
___________________
CEDULA ___________________ Place: ___________________ Date: ____________________

Others: ______________________________
I do solemnly swear that all information provided herein are true and correct.

_____________________________________________________
Applicant

This form is downloaded from www.pasay.gov.ph. The Official website of Pasay City Government