REPUBLIC OF THE PHILIPPINES

CITY OF CEBU
OFFICE OF THE MAYOR

BUSINESS PERMIT AND LICENSING OFFICE

SPECIAL PERMIT APPLICATION FORM

APPLICATION NO.
DATE:

(Name of Owner/Applicant/Representative)

(Name of Company/Agency)

Please check (/) applicable box:

EoBuvrRypERMrr npxHrsrr/pRoMorroN EEUN RLTNAIARATHoN

Eorsco Eruayon's cLEARANCE IsLUaRD
IcoNcr,Rr npanaoB/lvAlK D Others please specifr:
I uoroncADE/RECoRTDA/pRocES sIoN
FOR DELIVBRY PERMIT
DESCRIPTION OF VEHICLE PLATE NO. STICKER NO

Please attached OR and CR. If more than five (5) vehicles please hll-up separate sheet.
For FRANCHISEE, no need to secure delivery permit.

FOR EVENTS AND OTHER ACTIVITIES

DATE TIME PLACE/VENUE

Please attached the following requirements with /marks:

_Barangay Clearance _ Letter of Undertaking _OBO Clearance
_Police Endorsement Disaster Endorsement Business Permit
_CITOM Endorsement _Sports Commission Endorsement
_Contract with Venue _Amusement Tax Approval
_Route Map _Health Card or Sanitary Permit, if Food Exhibitor
For Mayorts Clearance please secure Prosecutor's Clearance, MTC Clearance, RTC Clearance and Police
Clearance.

Signature of Owner/Representative

Address
Contact No.