ERD.1.F.

003
Rev 04 06 November 2020
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APPLICATION FOR REGISTRATION AS
ECOZONE LOGISTICS SERVICE ENTERPRISE
8th-10th Floors, DoubleDragon Center West Building
DD Meridian Park, Macapagal Avenue, Pasay City 1202

__________________________
Date

BGen CHARITO B. PLAZA MNSA, PhD

Director General
Philippine Economic Zone Authority

Madam:

In accordance with Chapter II, Section 12 (c) of Republic Act 7916, otherwise
known as the Special Economic Zone Act of 1995, as amended by Republic Act
its Implementing
8748, and Rules and Regulations, I am applying for the registration of

(name of company)
as Ecozone Logistics Service Enterprise for the
establishment/installation of ______________________
(Nature of Project)

to be located at
(Name and location of Ecozone)

The undersigned attest that the documents/information submitted are true and are
correct and that I assume full responsibility for any misrepresentation and/or
violation thereof.

Attached hereto are:

1. Project Brief;
2. Notarized Secretary's Certificate;
. Certificate of Registration from the Securities and Exchange Commission /
Department of Trade and Industry and Articles of Incorporation;
. Resume or biodata of principal officers;
. Audited Financial Statements for the last three (3) years (if operating);
. Reservation form or similar document on building to be leased (if applicable);
. Favorable endorsement from the developer/operator
Very truly yours,

President/General Manager
 ERD.1.F.003
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PHILIPPINE ECONOMIC ZONE AUTHORITY
8th-10th Floors, DoubleDragon Center West Building
DD Meridian Park, Macapagal Avenue, Pasay City 1202

APPLICATION FOR REGISTRATION AS

ECOZONE LOGISTICS SERVICE ENTERPRISE

Date Filed
O.R. No.
Amount Paid

Applicant

Name of Firm
Address

Telephone No. Fax No.

E-mail Address Website

Applicant's designated Representative (s) to PEZA

Name Name
Address Address

Tel. No. Tel. No.

Fax No. Fax No.

Type of Application (Please Check)

New Ecozone Logistics Service Enterprise

Expansion/Additional Project
Amendment of Registered Activity

Site of Operation

Area Location
(Lot No. Block No. Phase etc.)
Name of Ecozone

Proposed Activity/ies
 ERD.1.F.003
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Project Brief

I. Management Profile

1. Name of Company

2. Business Registration
Office Date Registration No.

Securities and Exchange Commission

Department of Trade and Industry
Board of Investments
Others, please specify

3. Applicant's Parent Company or Management Company (if any)

Name
Address
Telephone No. Fax No.

4. Capital Structure
Amount Percentage Share
Authorized Capital
Subscribed Capital
Paid-up Capital
TOTAL

5. Major Stockholders (current)

Stockholder Nationality No. of Shares Amount Amount
Subscribed Paid-up

(use separate sheets if necessary)

6. Principal Officers (current)

Name Position Nationality

7. Manpower Requirement

Year 1 2 3 Average
Number of Manpower

8. Timetable of Project Implementation

Period
i.) Building construction/Improvement
ii.) Importation of machinery/equipment
iii.) Installation of machinery/equipment
iv.) Hiring/Training of Personnel
v.) Start of Commercial Operations
 ERD.1.F.003
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II. Technical Aspect

1. Project Description

a. Describe in detail what scheme(s) or warehousing services the applicant proposed to undertake in the zone, and
the goods to be handled in accordance with Board Resolution (B.R.) No. 97-366, as amended by B.R. No. 01-210,
the guidelines for registration and operation of Ecozone Facilities Enterprise engaged in warehousing operations.

b. Provide brochures, listing of goods to be handled under warehousing operations.

2. Operational Flowchart / Services Flow

(use separate sheets if necessary)

3. Machinery and Equipment (List, Sources and Cost)

Machinery and Equipment Source Unit Cost per Amount

Unit

(use separate sheets if necessary)

4. Waste Disposal System

(use separate sheets if necessary)

III. Market Aspect

1. Target Market

2. Selling Price (per product)

3. Projected Revenues
Year Revenues (US$)
1
2
3
 ERD.1.F.003
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IV. Financial Aspect

1. Estimated Project Cost

Amount
Site Development ______________________________________________
Building Construction/Improvement
Machinery Equipment, and Office Equipment
Pre-Operating Administrative Expenses
Working Capital
Other Costs

Total Cost

2. Sources of Funds (Note: Total amount should at least be equal to total project cost for one year)

Amount
Equity
Loans
Other sources

Total
 ERD.1.F.003
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ECOZONE LOGISTICS SERVICE ENTERPRISE

SECRETARY’s CERTIFICATE

_______________________of legal age, with business address at ___________________depose and

state:

That I am the duly elected Corporate Secretary of __________________________________(the

"Company"), a domestic corporation duly organized and existing under the laws of the Republic of the
Philippines, with principal office at _______________________________________.”

That at a duly convened meeting of the Board of Directors of the above Company held on ______,
the following resolutions were unanimously approved:

"Whereas the Company wishes to apply for registration of its ____________Project with
the Philippine Economic Zone Authority ("PEZA")";

"Now therefore, be it resolved, as it is hereby resolved, That, the Board authorize the
Company to proceed with its application for the registration of its Project with PEZA"; and

"Resolved, Further, as it is hereby resolved, That, the Board authorize the Company to
be designated representative of the Company in all dealings and transactions with PEZA in
relation to the registration of the Company's Project with the PEZA."

"That pursuant to the provisions of Section 3 and 14 of Republic Act 3019 (Anti-Graft
Act),the Company has not given or promised to give, and will not give, any gift to any officer
employee of the PEZA in connection with the processing of this application, nor it will give
such gift to any of said officers or employees after approval of this application."

"That based on the records of the applicant, no Board Member or Officer of the
Philippine Economic Zone Authority has an investment or other financial interest, direct or
indirect, in the Company."

That the foregoing is a true and correct copy of the resolution appearing in the minutes of the
Corporation and is, as of this date, in full force and effect.

In witness whereof, I have hereunto set my hand at _______________________ this ___ day of
___________ 20___.

___________________________________
Corporate Secretary

SUBSCRIBED AND SWORN to to before me this _____________________ in the City /

Province of ______________________. Affiant exhibited to me his Community Tax Certificate No. A.
_____________________________ issued at_______________________ on ______, 20___.

Notary Public
Until December 31, 20_____

Doc. No.
Page No.
Book No.
Series of 20____