APPLICATION FOR REGISTRATION AS

BARANGAY MICRO BUSINESS ENTERPRISE (BMBE)

BMBE Form 01
Date Application Filed :___________
Application No._________________

New Renewal ________________________________________

Certificate No. ___________ Name of Business Enterprise
Date Registered: __________ (DTI Business Name/ SEC Registered Name)
DTI Business Name /SEC Registration No/CDA Registration No._____________

Name of Owner (if Sole Proprietor)

Male Female
(Last Name) (First Name) (Middle Name)

Business _____ (House/Bldg. No.) ______________________________ (Bldg. Name) Telephone No.

Address ___________ (Unit No.) ____________________________ (Street) Mobile No.
_________________ (Barangay) ________________ (Subdivision) Fax No
_______________ (City/Municipality) ______________ (Province) Email
Branches (if any) _______________________________________________
Type of Business Organization
Single Proprietorship Partnership Corporation Cooperative
Association Others_______________________
Status of Business
New Existing
Principal Business Activity
Production Processing Manufacturing Trading
Services (Excluding those rendered by anyone who is Others______________
duly licensed by the government after having passed a
government licensure examination in connection with the
exercise of one’s profession)
Product Lines/Services
Other Businesses if any
 Yes No If yes, how many? ____________________________________
Total Assets (To the nearest Thousand Pesos excluding the value of the land on
which the business entity’s office, plant and equipment are located) Php
Total Number of Employees No. of Males: No. of Females:
Regular: Irregular/Part-time:
UNDERTAKING

I/We hereby declare, for purposes of Section 5 of RA 9178, that all information, including the business enterprise’s asset
size, supplied in this application which shall be the basis of assessing my eligibility for registering as BMBE are true and
correct to the best of my belief and knowledge. Any false or misleading information supplied, and/or production of
materially false or misleading document to support this application shall be ground for disapproval of BMBE
application/revocation of BMBE Certificate of Authority as well as ground for criminal, civil and/or administrative action
against our enterprise. I affirm under the penalties of perjury, that this declaration has been made in good faith.

I/We undertake to advise the Department of Trade and Industry through the Negosyo Center of any change in the status of
its ownership structure and shall surrender the original copy of the BMBE Certificate of Authority for notation of the
transfer.

Applicant’s/Authorized Representative’s Signature

Over Printed Name
 BMBE ELIGIBILITY CHECKER

CRITERIA YES NO
1. Is the total asset of your business not more than Three Million Pesos (P3,000,000.00)?
Note : Total asset refers to all kinds of properties, real of personal, including those arising from loans but
exclusive of the lang on which the particular business entity's office, plant, and equipment are situated, owned
by the BMBE and used for the conduct of its business.
2. Is your business engaged in the production, processing, or manufacturing of products or commodities
including agro-processing, trading, and services and the activities are barangay-based?
Note : Barangay-based business is any of the following conditions (i) the majority of its employees are residents
of the city/municipality where its principal place of business is located; or (ii) its principal activity consists in the
application/use of a particular skill peculiar to the locality or of raw materials predominantly sourced from the
area; or (iii) its business operations are confined within the territorial jurisdiction of the city/municipality or LGU
in which its principal place of business is located.
3. Is your business a branch, subsidiary, division or office of a large scale enterprise and its policies and
business modus operandi are determined by a large scale enterprise or by persons who are owners or
employees of the enterprise (i.e. franchises)?
4. Does your business provide services that are rendered/owned by (i) natural persons who are duly licensed
by the government after having passed a government licensure examination in connection with the exercise of
one's profession, and (ii) juridical persons such as partnerships or corporations engaged in consultancy,
advisory, and similar services where the performance of such services are essentially carried out through
licensed professionals (e.g. Lawyer, Accountant, Doctor, Pharmacist, etc.)?