Republic of the Philippines

Department of the Interior and Local Government

Bureau of Fire Protection
(Region)
(District/Province Office)
(Station)
(Station Address)
(Telephone No./Email Address)

Number: R-
Date

(Name of Owner)

(Name of Establishment)

(Address)

NOTICE TO CORRECT VIOLATION

Sir/Madam:

T h i s h a s r e f e r e n c e t o t h e N o t i c e t o C o m p l y i s s u e d b y t h i s o f f i c e o n for
compliance of your establishment/building located at the above cited address. Despite the length
of time that has elapsed and with re-inspection report under Inspection Order No. _________
dated ___________________fire safety requirements remain not complied.

In this regard you are hereby imposed an Administrative Fine of (P ) ______ pursuant
to Section 13.0.0.4 of IRR of RA 9514. Hence, you are given three (3) days to pay the fine at
__________________________________________________________________________.
(State name of Government Servicing Bank/Local Treasurer)

Hereto attached is the Order of Payment for your compliance.

Further, you are directed to comply with specific fire safety requirements in accordance
with the provisions of RA 9514. The following violations/deficiencies are hereby reiterated with its
corresponding grace period:

Defects/Deficiencies Grace Period

Failure on your part to pay the administrative fine and to correct the deficiencies within the
prescribed period, this office shall be constrained to recommend issuance of abatement order for
your establishment.

Very truly yours,

______________________________
CITY/MUNICIPAL FIRE MARSHAL

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG
MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

DISTRIBUTION:
Original (Applicant/Owner’s Copy)
Duplicate (BO or BPLO, as the case may be)
Triplicate (BFP Copy)

BFP-QSF-FSED-011 Rev. 01 (07.05.19)