ERD.4.F.

003
Rev. 02, Jan. 15, 2022

Republic of the Philippines PHILIPPINE ECONOMIC ZONE AUTHORITY

8th – 10th DoubleDragon Center West Building, DD Meridian Park Macapagal
Avenue, Pasay City
Tel. No. 551-3451 loc. 231 Website: www.peza.gov.ph email: sru@peza.gov.ph

APPLICATION FOR PEZA LETTER OF AUTHORITY /COMMITMENT/UNDERTAKING AS

PEZA-ACCREDITED SERVICE ENTERPRISE

I, __Owner / President’s Name________ of ___Company Name ____ with business address at

__________Address____________________, do hereby depose and say that:

1. I am the _(position)_____ of __(Name of Service Enterprise)_________________ with business address at

___________________________________________. I am duly designated and authorized to apply with
the Philippine Economic Zone Authority for authority to provide __(Trucking/Hauling, Freight Forwarding,
Custom Brokerage, Security Agency)__ services to PEZA-registered enterprises;

2. The following are basic information on ___(Name of Service Enterprise)_’s_______;

Applicant’s Existing Business Registration with:
Date Registration No.
Securities and Exchange Commission __________________ ___________________
Department of Trade and Industry __________________ ___________________
Business/Mayor’s Permit: __________________ ___________________
BIR Tax Identification Number __________________ ___________________
Principal Officers:
Name Position Signature
___________________ ____________________________ ____________________
___________________ _____________________________ ____________________
___________________ _______________________ ____________________

Company Contact Details: Authorized Personnel:

Telephone Number/s: __________________ Telephone Number/s: ___________________
Email address: ______________________ Email address: ________________________

Personnel authorized to transact business with PEZA:

Name Position Signature
_______________________ _______________________ ______________________

Applicable Licenses, Clearances and other Permits

Trucker and Hauler Number Validity
LTFRB Franchise/Provisional Authority
Licensed Broker
BOC Registration
Freight Forwarder
Certificate of Registration from the Civil
Aeronautics Board - (for Air Freight)
Certificate of Accreditation from Dept. of
Trade & Industry - Fair Trade Enforcement
Bureau (DTI-FTEB) – (for Sea Freight)
Security Agency
PNP License to Operate
DOLE Registration (DO174)

3. Attached hereto are copies of required permits, licenses and other requirements (as enumerated in the
PEZA checklist of requirements) to support the application of ____(Name of Service
Enterprise)’s_______________________;

4. I/We therefore hereby commit and undertake to comply with PEZA rules and regulations including the
following conditions:
a. That the PEZA Letter of Authority (LOA) issued to (Name of Enterprise) shall always be made available
for reference to PEZA-registered enterprise client/s and the PEZA Zone personnel where the
PEZAregistered enterprise client/s is/ are located;

b. We attest that the employees and personnel, including truck drivers and helpers, have good moral
standing prior to their employment, and are authorized to transact business for our PEZA operations;
any new personnel and those who are no longer in our employ during the validity of the LOA shall be
submitted to the PEZA-Office of the Deputy Director General for Operations / Service Registration Unit;

c. Should we need to subcontract or hire the services of other freight forwarders, customs brokers, and/or
truckers for our PEZA-enterprise clients, we shall engage the services only of PEZA-authorized service
enterprises, and shall be held responsible for the actions of the said entity/ies;

d. __(Name of Enterprise)_______ shall ensure that its licenses from the regulatory-issuing government
agency are valid during the entire validity of the LOA issued by PEZA.

e. The terms and conditions stipulated in agreements between and among the PEZA and other
government agencies shall be complied with accordingly;

f. We shall secure PEZA vehicle sticker at the PEZA-Service Registration Unit, subject to submission of
documentary requirements or Unified Logistics Pass (ULP) QR code from LTFRB, whichever is
required.

g. Pursuant to the provisions of Section 3 and Section 14 of R.A. 3019 (Anti-Graft Act), we did not give or
promise to give and will not give any gift to any officer or employee of the Philippine Economic Zone
Authority in connection with the filing and processing of our application.

h. We confirm that no Board Member or official and/or employee of PEZA has an investment or other
financial interest, direct or indirect, in our company;

i. Should we opt for renewal of the LOA, a letter request shall be filed with PEZA not later that fifteen (15)
days prior to expiry hereof duly supported by the documentary requirements. Any delay in the filing of
our renewal shall result to our payment to PEZA a penalty equivalent to one percent (1%) of the
franchise fee per month of delay.

j. We acknowledge that the three (3)-year validity of the LOA is subject to annual submission to PEZA-
SRU of applicable permits, licenses and other documentary requirements as listed under PEZA
Memorandum Circular No. 2022-02 dated 29 December 2021 and payment of the annual Franchise fee
of Php6,000.00, due fifteen (15) days before the expiration of 2nd and 3rd year of the LOA. Failure to
comply with the annual requirements within the prescribed period, will automatically remove our
company from the list of PEZA-accredited service enterprises.

k. ___(Name of Enterprise___ shall render PEZA free and harmless from liability, responsibility, claims or
payment resulting from their operations including that of their employees, including any liability in the
event of any issues arising in case _____(Name of Enterprise)________ continued to handle PEZA
clients even without a valid license from regulatory-issuing government agency.

l. _____ acknowledges that any misrepresentation/falsification/ tampering in the documents and/or

information submitted to PEZA in relation to ___________ ’s application for authority, which may
later be discovered by PEZA and/or non-compliance with any terms and conditions of the LOA
and any existing PEZA and other regulatory agencies rules and regulations shall be cause for
imposition of applicable penalties as provided by PEZA, including suspension or revocation of
this authority.

m. We acknowledge that this authority shall be automatically suspended, in case of violation of any of the
terms and conditions herein or if any of our personnel are involved in diversion, pilferage, or hijacking of
shipment of PEZA enterprises, and/or any other irregular/illegal activity, without prejudice to any further
administrative sanctions which PEZA may take, in which case, the liability of any of our personnel shall
extend to the company.

n. We will notify PEZA – Office of the DDG – Operations / Service Registration Unit in writing of any
change of address and contact details within seven (7) working days when the change is effected.

o. We shall comply with all existing labor laws, i.e., minimum wage, cost of living allowance, 13th month
pay, services incentives leave pay, overtime pay, night differential pay, public holiday, retirement
benefits, SSS, PHILHEALTH, PAG-IBIG and ECC premium contributions and other mandatory benefits
as provided by law.
2
 ________________________________
NAME & SIGNATURE
President
Authorized representative / Designation
Authorized by:

________________________________
President
(if signed by authorized representative)

SUBSCRIBED AND SWORN to before me, a Notary Public, this _____ day of ____________________ at
_____________________ City, affiant exhibited to me his/her _______________ ______________ at
______________.

Doc. No.
Page No.
Book No.
Series of 2020

Fee/s Paid Amount O.R. No. Date Paid

Application Fee
Franchise Fee
Others; pls. specify

(Please provide two (2) original copies for PEZA-personnel and for the personal/company use