CITY OF BACOOR BUSINESS PERMIT AND LICENSING OF TAX YEAR o Mode of Payment TH Amcrdmest DiRenewat DaAnnual J From Single to Parership Dsemi-annuat Cy From Single to Corporation Douarerty From Partnership to Single BW ransr {D From Partnership io Corporation Tlowncrship {From Corporation to Single Dihocaton {D1 From Corporation to Partnership Date oF Application DTVSECICDA Registration No ‘Aseount No, [DTVSECICDA Date of Registration No ‘Type of Organization” Single LJParinership L[Corporation [J Cooperative (CTC Nos THN: ‘Are you enjoying tax incentive from any Government Entity? _— C1Yes__ LJNo Please specify the entity ‘Name of Taxpayer/Corporate Name: Last Name: First Name: Middle Name: Business Name: ‘Name of President/ Treasurer of Corporation Tast Name: [First Name [Middle Namer Business Address ‘Owner's Address: Touse No Bldg. No_& Bldg. Name Tlouse No/ldg, No & Bldg. Name Unit No, Sweet No. & Steet Name: Unit No,/Sireet No. & Slreet Name: Block No LotNoz — Phase No, Block No Lot No Phase No. Subdivision Subdivision: Barangay Barangay: ‘Ciry Munieipaliy Cir Municipay Province Province “Tel No. & Mobile No “Tel. No. & Mobile No Email Address Email Address Property Index Number PIN}: Business Area (in sq/m} [Total No, of Employees: No, of Employees residing in Cily Munveipatiy: Tr Place of Business is Rented, please entity the following: Lessor's Namer ‘Gross Monthly Renal Last Name: [First Name: [Middie Namez Tessor's Address House No,/Bldg. No, & Building Name: Cry Manipal Sureet No. & Steet Name: Province Subdivision “Tel. No, /Mabile Nor Barangay: Email Address Business ActRy No.of Capitalization Grows Safea Receipts for Renewal) Cade Tine of Business Units (or New Business) Essential ‘Non-Essental Oath of Undertaking: "underike to comply with the regulatory requirement and other deficiencies within 30 ays from release ofthe busines permit the auiomatic revocation and cancelation of he same Any violations and non compliance shall mean SIGNATURE OF APPLICANT OVER PRINTED NAME REGULATORY FEES. AMOUNT DUE [PENALTY [TOTAL ‘ASSESSED/VERIFIED BY ‘Sanitary Inspection Fee Fire Inspection Fee Building Inspection Fee Electrical Inspection Fee Plumbing Inspection Fee ‘Siguboard Billboard Fee ‘Mechanical Inspection Fee Zoning Inspection Fee. Others, please specify Assessment reviewed by. Approved By: HON. LANI MERCADO - REVILLA City Mayor Approval recommended by FRANCISCO J. OCAMPO. Department Head ‘SUBSCRIBED AND SWORN TO BEFORE ME this___ day of. at the City/Municipality of. Community Tax Certificate No, ies at am Doe. No, Page No. Book No, Series of Business Plate No. OR No./Date Sticker No, affant exhibited to me histher