Republic of the Philippines

BARANGAY MAPULANG LUPA

Valenzuela City
OFFICE OF THE PUNONG BARANGAY
APPLICATION FOR BARANGAY CLEARANCE STORE
(BUSINESS)
CLEAR NO. : ___________________ DATE: ____________________

( ) NEW ( ) RENEWAL ( ) OTHERS __________________________________

NAME OF APPLICANT OR REPRESENTATIVE: ________________________________________
_

A D D R E S S: _____________________________________________________________________
POSITION IN BUSINESS : _________________________________________________________
NAME OF BUSINESS : _________________________________________________________
NATURE OF BUSINESS : _________________________________________________________
NUMBER OF EMPLOYEES: _________ START OF OPERATION: _________________________
LOCATION OF BUSINESS : _________________________________________________________
NAME OF OPERATION /MANAGER / OWNER: ________________________________________
TEL.NO. OFFICE: ________________________ RESIDENCE_______________________________
REQUIREMENTS:
1. CTC Individual of owner (if single prop.) or
CTC Corporation (if partnership or Corporation)
2. D.T.I. / SEC Registration for new applicants (New)
3. Lease of Contract if place of Business is rented (New)
4. Previous Mayor’s Permit/ License w/ latest payment
New Application Form for Mayor’s Permit for Corp.
5. Sketch of Business location (at the back)
6. Other/s ________________________________________

________________________________
APPLICANT’S SIGNATURE
REMARKS:
( ) APPROVED CTC NO. I/C : ____________________
__________________________________ ISSUED AT : ____________________
ISSUED ON : ____________________
( ) DISAPPROVED AMOUNT : Php. ________________
REASON/S_________________________
___________________________________
CLEARANCE FEE: Php. ____________
O.R. NO. : ____________________
DATE : ____________________

INSPECTED BY: APPROVED:

__________________________________ _________________________________
Barangay Official / Kagawad HON. FERNANDO C. FRANCISCO
Business Application Form. YOLLY D.M Punong Barangay
 Republic of the Philippines
BARANGAY MAPULANG LUPA
Valenzuela City
OFFICE OF THE PUNONG BARANGAY
APPLICATION FOR BARANGAY CLEARANCE
FOR BUSINESS ESTABLISHMENT (COMPANY)

CLEAR NO. : ___________________ DATE: _____________________

( ) NEW ( ) RENEWAL ( ) OTHERS __________________________________

NAME OF APPLICANT OR REPRESENTATIVE: _______________________________________
ADDRESS: ________________________________________________________________________
NAME OF BUSINESS : _________________________________________________________
NATURE OF BUSINESS : ________________________ KIND OF OWNERSHIP: ___________
NUMBER OF EMPLOYEES: _________ START OF OPERATION: _________________________
BUSINESS ADDRESS: ______________________________________________________________
NAME OF OWNER :________________________ NAME OF MANAGER: ___________________
TEL.NO. OFFICE: ________________________ RESIDENCE_______________________________
REQUIREMENTS:
1. CTC Individual of owner (if single prop.) or (New / Renewal)
CTC Corporation (if partnership or Corporation) (New / Renewal) 2x2 picture
2. D.T.I. / SEC Registration for new applicants (New) Xerox Copy (owner)
3. Lease of Contract if place of Business is rented (New) Xerox Copy
4. Previous Mayor’s Permit/ License w/ latest payment
(4th quarter Renewal or Annual (Xerox Copy)
5. 2x2 picture of owner (New)
6. Sketch of Business location (at the back)
7. Other/s __________________________________

__________________________________
Signature of Applicant/Representative
____________________________________
Position/Title
REMARKS:
( ) APPROVED CTC NO. I/C : ____________________
__________________________________ ISSUED AT : ____________________
ISSUED ON : ____________________
( ) DISAPPROVED AMOUNT : Php. ________________
REASON/S_________________________
___________________________________
___________________________________ CLEARANCE FEE: Php. ____________
O.R. NO. : ____________________
DATE : ____________________

INSPECTED BY: APPROVED:

__________________________________ _________________________________
Barangay Official / Kagawad Hon. FERNANDO C. FRANCISCO
Punong Barangay
Business Application YOLLY D.M