Application Forms for New Maird

Form No.01

Department of  Transportation & Communications LAND TRANSPORATION OFFICE East Avenue, Quezon City NEW APPLICATION FOR ACCREDITATION OF MANUFACTURER/ASSEMBLER/IMPORTER/REBUILDER/ DEALER OF MOTOR VEHICLES AND/OR ITS COMPONENTS DATE:  __________________  _____________________ ___  ____________________________ ___________________ __________________ __________________ ___________________ ____________ __ BUSINESS NAME :  __________________  ____________________________ ___________________ ___________________ __________________ __________________ ___________ __ BUSINESS ADDRESS:  ___________________  __________________  ___________________________ __________________ ___________________ ___________________ __________________ __________________ ___________________ ____________ __  ____________________________ ______________ _____ CONTACT NO. :  ___________________

CL ASSICATION

:

Manufacturer Assembler Importer

Chassis body 4Wheels 3Wheels Brand New MV (CBU)

Used Components Rebuilder Dealer

Truck Bus Car UV Truck Trailer Others _________ Others ___________ __

Other___________ 2Wheels Other _________ Other  ____________ ___

Used or second hand MV Other ________ Other  __________ __ Other___________ SUV Bus Motorcycle Component

DOCUMENTARY REQUIREMENTS General Requirements ( ) Certified true copy/ies of Securities of  Securities and Exchange Commission Certificate of Registration of  Registration and Articles of  Incorporation/Partnership and By‐Laws for Corporation/Partnership ( ) Certified true copy/ies of DTI of  DTI Certificate of Business of  Business Name of Registration of  Registration for Sole Proprietorship ( ) Certified true copy/ies of  Mayor’s Permit for: ( ) Plant if applying if  applying for Manufacturer & Assembler ( ) Warehouse if applying if  applying for Importer ( ) Rebuilding Center if applying if  applying for Rebuilder ( ) Display Center if applying if  applying for Dealer ( ) Financial Statement (Statement of  Assets and Liabilities) duly certified by CPA ( ) BIR Certificate of  Registration ( ) SSS Certificate Of  Membership ( ) Location Map ( ) Picture of Establishment of  Establishment ( ) Contract of  Lease / Transfer Certificate of  Title ( ) Undertaking under oath by sole proprietor or highest ranking company official that all

Stocks to be reported are compliant with all Philippine laws, rules and regulations relating to manufacture, assembly, importation, registration and use in the Philippines. Additional Requirement for Assembler ( ) Certified true copy/ies of DTI of  DTI Board of Investment of  Investment (BOI) Certificate of Membership of  Membership Additional Requirement for Rebuilder ( ) Certified true copy/ies of DTI of  DTI Certificate of Accreditation of  Accreditation of Rebuilding of  Rebuilding Center

 __________________  ___________________________ __________________ ____________ ___ Printed Name & Signature of Applicant of  Applicant and/or Authorized Representative

 _________________  __________________________ _________ Designation

SUBSCRIBED AND SWORN to before me this  ___ day of  __________ of   _________________, _______, affiant exhibiting to me his/her Residence Certificate No.  _______________  _______________ issued at  _______________  _______________ on____________ Doc. No. ______ No.  ______ Page No. ______ No.  ______ Book No. ______ No. ______ Series of  ______  ______ NOTARY PUBLIC