application for renewal of contractor license

8/4/2019 Application for Renewal of Contractor License

1/22

PCAB Form No. 201

APPLICATION FOR RENEWAL OF CONTRACTOR'S LICENSEwith the PHILIPPINE CONTRACTOR'S ACCREDITATION BOARD

The following pertinent documents and information are to be submitted in support of the license application of said firm:

Checklist for Renewal Application A. Legal [ ] 1. General Information (PCAB Form Nos. 201a and 202);

[ ] 1.1 Certified true copy of subsequent amendments (if any) to Articles of Incorporation and/orBy-Laws in case of Corporate or Partnership applicant;

[ ] 1.2 For change in address only: Business Permit from the municipality/city where the principal office of theapplicant is located, or any other official document showing the new office address of the applicant.;

B. Financial [ ] 2. Certified true copy of the Annual Income Tax Return filed with the BIR for the taxable ye

ar immediatelypreceding the filing of renewal application;

[ ] 3. Financial Statements (duly audited and signed on every page by a PRC-BOA accredited external auditor) as ofthe end of the taxable year immediately preceding the filing of application duly filed with the BIR and a diskette/CD (compact disc) containing the firms Audited Balance Sheet & Income Statement in the prescribedtemplate (PCAB Financial Statement downloadable from the DTI Website atwww.dti.gov.ph together with thepertinent application forms)Documents in support of new acquisition:

[ ] 3.1 If increase is due to additional capital infusion[ ] 3.1.1. Cash Original copy of Bank Certification/Bank statement of account certified by Bank Manager of cash

deposits as of Balance Sheet date;

Authorization to Depository Bank (PCAB Form No. 203a);[ ] 3.1.2 Land and Building - List of Land and Building/s owned by the company and registered in its name

(PCAB Form No. 204a);

Certified true copy of TCT including back page for newly acquired land and/or condominium whichwere not previously reported/submitted to PCAB.

[ ] 3.1.3 Transportation & Construction Equipment - List of Construction and/or Transportation/DeliveryVehicles/Equipment/Machineries/Plants owned by the company and registered in its name,(PCAB Form No. 204b); Certified true copy by the LTO of the LTO Certificate of Registration and current Official

Receipt of Registration of newly acquired registrable Construction and/or Transportation/Delivery Vehicles/Equipment

Certified true copy of Deed of Sale or sales invoices/official receipts for newly acquirednon-registrable construction equipment/machineries/plants, or newly acquired constructionequipment

[ ] 3.1.4 Additional documents to be submitted only if applicant's Inventories and Receivables Accountsare more than 20% and 20% of Networth, respectively:

[ ] 3.1.4.a Schedule of Inventories (PCAB Form 209);[ ] 3.1.4.b Schedule of Receivables. (PCAB Form 209);

3.2 If increase is due to appraisal of properties[ ] 3.2.1. Independent Appraisers Report

[ ] 4. Authorization to BIR & other agencies (PCAB Form No. 203);C. Experience of Firm

[ ] 5. Statement of Annual Value of Work Accomplished (PCAB Form 205);

D. Technical[ ] 6. List of STEs (PCAB Form No. 204) supported by applicable documents (listed below) for each STE;

For newly nominated STE/s:

[ ] 6.1 STE Affidavit/s (PCAB form 206) with a passport size picture/s of the new STE/s; [ ] 6.1.1 Certified true copy of valid PRC ID of STE as licensed professional or original

Certification of Good Standing for those awaiting issuance of new or renewed PRC ID.[ ] 6.1.2 NBI clearance/s of new STE/s;

[ ] 6.2 STE Affidavit/s of Construction Experience (PCAB Form 207);[ ] 6.3 Personal Appearance Form duly accomplished and signed by the STE/s appearing before thedesignated officer of the PCAB or the nearest DTI regional/provincial office (PCAB Form No. 208)

For previously nominated STE/s:[ ] 6.4 STE Affidavit/s (PCAB form 206);

[ ] 6.4.1 For STE/s below 60 years old: Certified true copy of the pertinent page of CCL(formerly SSS Form R-3) submitted to SSS for the quarter immediately precedingthe filing of application;

[ ] 6.4.2 For STEs 60 years old and above: Certified true copy of Certificate of Income TaxWithheld on compensation (BIR Form 2316, formerly BIR W-2) for the taxable yearyear immediately preceding the filing of application issued by the firm to the employeeand duly stamped received by BIR/ or accredited bank.

Others: PCAB Response Form (self-addressed and with sufficient stamps affixed)

NOTE: Original signature of Proprietor/AMO on each & every page of application forms including supportingdocuments (except item 6.3).

: Photocopies of documents in lieu, of certified true copies are accepted provided the original copiesare presented for authentications.

DO NOT FILL (For PCAB use only)

Total No. of Pages Submitted: _______ Checklisted by: _____________________________

[ ] Self-stamped envelopes * (no. ______ ) Name over Signature/Date

Remarks: _________________________________ ________________________________________ _________________________________________ ________________________________________

* One for each depository bank; one each for BIR, LTO, & LRA; and one for each vendor of non-registrable construction equipment reportedRevised 03/06/07
http://www.dti.gov.ph/http://www.dti.gov.ph/http://www.dti.gov.ph/


2/22

PCAB Form No. 201a

In behalf of ________________________________________________________________,(Name of Firm)

holder of Contractor's License No. ___________, originally issued on __________________,I hereby request for Renewal of its Contractor's License for Contracting Fiscal Year 01 July 200___to 30 June 200___.

I hereby certify to the completeness of the information/documents contained

in this applicationappertaining to the category/classification the company is applying for and that they are true andcorrect.

I am fully aware that:

1. all documents submitted in support of this application are subject to verification before PCABaction;

2. any discovered misrepresentation of information and/or manifestations of fraud on theapplication documents submitted by my firm applicant or its AuthorizedRepresentative/Agent/Liaison Officer shall be subjected to investigation which may result to thedisapproval of my application, denial/suspension/revocation of license and blacklisting of myfirm and myself as its Authorized Managing Officer; and

3. unconfirmed information/documents submitted to support my firm's qualifications will beexcluded for categorization/classification purposes.

4. the evaluation of my application's qualification shall be solely based on the documentssubmitted at the time the application was filed/accepted by PCAB.

_______________________________ Authorized Managing Officer (Signature over Printed Name)

Republic of the Philippines)______________________)S.S.

SUBSCRIBED AND SWORN TO before me this ________ day of ___________________ 20____ at______________________; affiant exhibited to me his Community Tax Certificate No. _______________issued at __________________ on _________________ 20 ___.

DOC. NO. _______________;PAGE NO. _______________;_________________________BOOK NO._______________; NOTARY PUBLICSERIES OF_______________. (Until December 31, _______)


3/22

PCAB Form No. 202

GENERAL INFORMATION

A. CONTRACTORS IDENTIFICATION

Name of Firm:

Office Address: Tel./FaxNo:

If Provincial based, contact address in Manila, if any: Tel./Fax No:

Website: E-mail Address:

Type of Organization (Please Check):[ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Joint Venture

SEC/BTRCP Registration No.: Date of Registration: SEC/BTRCP Expiry Date:

Employers I.D. No.: Tax Identification No.:

Original Contractor's License No.: _______________ Date of Issue: _____________

License was last renewed during CFY 20 _____- 20 _____

PRESENT CATEGORY:

PRESENT CLASSIFICATION/S:

Principal:

Others:

B. OWNERS/STOCKHOLDERS/OFFICERS* (For Corporation, Partnership and Joint Venture)

Name Position Nationality CapitalSubscription

Paid-UpCapital

C. AFFILIATION WITH OTHER LICENSED CONTRACTORS

Name of Affiliated Firm Nature of Affiliation

CERTIFIED CORRECT BY:

____________________________________Authorized Managing Officer(Signature over Printed Name)

Revised 03/31/04


4/22

PCAB Form No. 203

AUTHORIZATION

The Philippine Contractors Accreditation Board(PCAB) is hereby authorized to verify and

secure information and/or copies of documents submitted by or in the name of the firm to any or all of the

following agencies relative to its application filed with the PCAB:

1. Bureau of Internal Revenue

2. Securities and Exchange Commission

3. Land Registration Authority

4. Land Transportation Office

5. Social Security System

Name of Applicant Firm

_____________________________________

By:

_____________________________________

Signature over Printed Name of Proprietor

or Authorized Managing Officer

Date: _________________________________

03/31/04


5/22

PCAB Form No. 203a

THE MANAGER_________________________________

__________________________________________________________________

Subject: Account # _______________________

Sir:

Please provide the Philippine Contractors Accreditation Board(PCAB), a government agency under the

Department of Trade and Industry, any information they need regarding the subject account with your bank.

I am applying for a contractor's license from PCAB and part of their evaluation process is the verification ofbank deposits and other assets of an applicant.

This will serve as your authorization to release any information that may be requested by PCAB regarding the

above subject account.

Thank you.

Very truly yours,

___________________________________

Signature over Printed Name

___________________________________

Company Name

___________________________________

Date

Note: To be submitted in two (2) copies.

Revised 03/31/04


6/22

PCAB Form No. 204

LIST OF NOMINATED SUSTAINING TECHNICAL EMPLOYEES OF THE COMPANY

NAME

PRC REGISTRATION Date

Employed

Position

in the FirmNumber Date Profession

May be reproduced if necessary Revised 03/31/04

_________________________________________Signature over Printed Name of AMO

_________________________________________Company Name

_________________________________________PCAB License No. (If applicable)

________________________________________Date Signed

CFY __________________

Type of Application: (Pls. check) New Upgrading Renewal Others, pls. Specify__________________________

__________________________ __________________________


7/22

PCAB FORM 205

STATEMENT OF ANNUAL VALUE OF WORK ACCOMPLISHEDAs of the year ending _______

PROJECT PARTICULARS: 1 2 3

Title of project:

Project owner:

Location:

Classification/Total

Cost :/ / /

CONTRACT PARTICULARSDate of contract:

Contract completion

time :

Scope of work:

Amount of contract:

Name of Main

Contractor or Joint

Venture Partner, ifany:

WORK ACCOMPLISHMENT

As of start of year: ______________ %_____ ______________ %_____ _____________ %______

As of end of year : ______________ %_____ ______________ %_____ _____________ %______

TECHNICAL EMPLOYEE(S)

Name andProfession:

Position Title:

*** NOTES: See instructions at the back before filling up this form. This may be reproduce if necessary. *** Revised 03/31/04

_______________________________________

Signature over Printed Name

________________________________________

Company Name

________________________________________

PCAB License No.


8/22

INSTRUCTIONS ON FILLING-UP PCAB FORM-205

PROJECT TITLE refers to the name of the particular project as stated in the contract.

PROJECT OWNER refers to either government infrastructure agencies(e.g. DPWH, LWUA, MWSS, NIA, DOTC, etc.)

LOCATION refers to the site of the particular project.

CLASSIFICATION refers to the coverage or type of the work as stipulated in the contract. Choose acode of the following: (e.g. GE-1, GE-3, GB-1, SP-5, etc.)

GENERAL ENGINEERING SPECIALTYGE-1 Road, Highway Pavement, Railway SP-FP Foundation or Piling Work

Airport hor. Structure & Bridges FP1Piling WorkGE-2 Irrigation or Flood Control FP2

Soil Stabilization/SlopeGE-3 Dam, Reservoir or Tunneling Protection/Reinforced Earth

GE-4 Water SupplySP-SS Structural Steel Works

GE-5 Port, Harbor and Recreation Work SP-CC Concrete Pre-Casting,Pre-stressing, or Post-Tensioning

SP-PS Plumbing and Sanitary Work GENERAL BUILDING SP-EE Electrical WorkGB-1 Building and Industrial Plants SP-MEMechanical WorkGB-2Sewerage and Sewage System SP-AC Air-Conditioning or RefrigerationGB-3 Water Treatment Plant& System SP-ES Elevator and EscalatorGB-4 Park, Playground and Recreation Work SP-FW Fire Protection Work

SP-WP Water Proofing WorkSP-PN Painting Work

SP-WDWell Drilling WorkSP-PP Power Generating Plants/

Power Transmission & DistributionFacilities

SP-CF Communication FacilitiesSP-MS Metal Roofing & Siding InstallationSP-SD Structural DemolitionSP-LS Landscaping

SP-NF Navigational FacilitiesSP-EM Electro Mechanical Work

TOTAL COST refers to the overall project cost inclusive of owner furnished materials but exclusive ofdesign and engineering fees and may be in the nature of a budgetary estimate.

DATE OF CONTRACT refers to the date the contract was signed.

CONTRACT COMPLETION TIME refers to the date the project will be finished or completed.

SCOPE OF WORKrefers to the extent of involvement in the contract whether:(a) Main Contractor, (b) Sub-Contractor or (c) Joint Venture.

AMOUNT OF CONTRACT refers to the contract sum of the applicant firm inclusive of anychange/variation/order/addition or deduction.

NAME OF MAIN CONTRACTOR or JOINT VENTURE PARTNER indicate the name of the MainContractor or Joint Venture Partner if the project undertaken is a sub-contract.

WORK ACCOMPLISHMENTS - AS OF START AND END OF YEAR refers to the stage of completion ofthe contract work as of the first day and the last day, respectively, of the calendar/fiscal year, based onthe contract billings (indicate the value and percent accomplishments).

TECHNICAL EMPLOYEE(S) IN-CHARGE OF PROJECT refers to the Engineer or Architect assigned tosupervise the actual construction implementation (indicate the name, profession and position title of theSTE).


9/22

PCAB Form No. 206

Republic of the Philippines )Province of _____________ )Municipality of ___________) S.S.

STE AFFIDAVIT

I,______________________________________________________________________, Filipino, of legal age,LAST NAME FIRST NAME COMPLETE MIDDLE NAME

born on single/married to _____________________________________________and M M / D D/ Y Y Y Yresiding at ____________________________________________________________________ having duly sworn inaccordance with law depose and say:

1. That I am a duly licensed __________________________ and holder of PRC registration no. ___________(PROFESSION)

valid up to _______________ (copy of my PRC is attached at the back hereof);

2. That I hold a Bachelor's Degree in _____________________________________________________ at________________________________________________ given on ______________________;

(NAME OF SCHOOL)

3. That my Tax Identification Number (TIN) and Social Security No. are - -

and - - respectively;

4. That I am not presently employed in any government office or government owned/controlled corporation, nor a full timeinstructor, nor working abroad;

5. That I am employed by _________________________________________________________________(NAME OF FIRM)

on regular and full-time basis with the position of _________________________________and presently beingnominated as Sustaining Technical Employee for CFY _____________;

6. That I am not a holder of a contractor's license;

7. That I am not involved in any construction malperformance suggestive of negligence, incompetence or malpracticeor any act of omission liable for disciplinary action by myself or in collaboration with any other person;

8. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude;

9. That I am fully aware that my failure to notify the PCAB of my disassociation with my present employer shall causemy disqualification to be sustaining technical employee or authorized managing officer or a license applicant withPCAB;

10. That I authorize the PCAB to verify and investigate any or all information in this affidavit from whateversources PCAB may consider appropriate;

11. That I am executing this affidavit to attest to the truth of the foregoing.

FURTHER AFFIANT SAYETH NAUGHT.

_________________________________Affiant

SUBSCRIBED and sworn to before me this _____ day of ___________________, 200___ affiant exhibited his/herCommunity Tax Certificate No. _____________ issued at ___________________ on ______________.

Doc. No. __________;Page No. __________;Book No. __________; Notary PublicSeries of 200 _______. Until December 200 ___

CFY ___________________Type of Application: (Pls. check)

New Upgrading Renewal Others, pls. specify__________________________

____________________________________________________

Revised 03/31/04

Passport size

Picture of STE


10/22

INSTRUCTIONS ON FILLING UP PCAB FORM NO. 206

QUALIFICATION REQUIREMENTS OF SUSTAINING TECHNICAL EMPLOYEE

1. A technology professional, such as engineer or architect, duly license by the Professional Regulation Commission.

2. Holder of Professional I.D. valid for current year.

3. Possesses at least (3) years of experience in implementation of construction to which he is to be nominated.

4. A full-time employee of the nominating contractor, not associated professionally or by employment with any otherparty, particularly a party engaged in construction or construction-related activities.

5. Have none of the following disqualifications:

a) Involvement, in any capacity, in any construction malperformance of grave consequence,suggestive of his negligence, incompetence and/or malpractice;

b) Involvement, by himself or in collaboration with any other person or firm, in any act or omission Liablefor disciplinary action of which he or the other person or firm was found gguilty by the Board;

c) Conviction by a court of competent jurisdiction of any offense involving moral turpitude;and

d) If formerly a Sustaining Technical Employee or an Authorized Managing Officer of any Constructionfirm but disassociated therefrom, failure to notify the Board of his disassociation in accordance with

paragraph 5 and 6 of the Affidavit of Undertaking.

6. Not a holder of a contractor's license.

If you meet the above requirements, kindly accomplish this affidavit. Erasure must be properly initialled.

All statements are subject to verification and any false statement or willful misrepresentation of a material fact inobtaining a license shall be grounds for disapproval of this application.

PASTE

PROF. I.D. CARD

VALID FOR

CURRENT YEAR

(Front)

(xerox copy)

PASTE

PROF. I.D. CARD

VALID FOR

CURRENT YEAR

(Back)(xerox copy)

This is to certify that I have verified with PRC the abovestated professional eligibility/registration of theSustaining Technical Employee. Affiant herein and found the same to be true and correct.

__________________________________________

AUTHORIZED MANAGING OFFICER

Date: __________________


11/22

PCAB Form No. 207

Republic of the Philippines )Province of _____________ )Municipality of ___________) S.S.

AFFIDAVIT OF STE CONSTRUCTION EXPERIENCE

I, _____________________________ ____, single/married, Filipino, of legal age, with postal address at_________________________________________ _______, having been duly sworn in accordance with lawdepose and say that the projects enumerated below constitute my full & complete construction experience.

NAME andCOMPLETE ADDRESS of EMPLOYER/

NAME & LOCATION of PROJECTS UNDERTAKEN

WorkClassification(GE, GB, SP)

Nature/Scope ofWork Assignment

(Proj. Engr.)

PROJECTDURATION

(mm/dd/yy)

From To

That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCABmay consider appropriate;

That I am executing this affidavit to attest to the truth of the foregoing.

FURTHER AFFIANT SAYETH NAUGHT.

_________________________________Affiant

SUBSCRIBED and sworn to before me this _____ day of _________________, 200__ affiant exhibited his/herCommunity Tax Certificate No. ______________ issued at ____________________ on ____________________.

Doc. No. __________;Page No. __________;Book No. __________; Notary PublicSeries of 200 _______. Until December 200 ___

CFY ___________________ Company Name____________________________

Type of Application: (Pls. check) PCAB License No. _________________________

New Upgrading Renewal Others, pls. specify___________________________

___________________________ Revised 03/31/04


12/22

PCAB Form No. 208

SUSTAINING TECHNICAL EMPLOYEE (STE) PERSONAL APPEARANCE FORM(To be accomplished fully by the STE)

Name: ______________________________________________ Sex: _____________

Address: _______________________________________________________________

Profession: __________________________________ PRC Reg. No.:_____________Nominating Firm: _______________________________________________________Contractor's License No.: ______________________

I hereby confirm the following:

1. The veracity of the information reflected on the STE Affidavit and Affidavit of Construction Experience

(PCAB Form Nos. 107 & 108, copies attached) that I executed in favor of the above firm;

2. That I am fully aware that my failure to notify the PCAB of my disassociation from the above-stated

nominating firm and any misrepresentation in the attached forms shall cause my disqualification as

sustaining technical employee, or authorized managing officer, or a licensee applicant with PCAB perBoard Resolution No. 401, Series of 2001.

3. That I have been previously connected with the following companies:

Previous EmployersDate of

Employment

Date of

Resignation Position

4. Other Remarks:

_____________________________________________________________________________________________________

____________________________________________________________________________________

______________________________STE's Signature

Date Signed: ______________________

Identification Documents Presented:

PRC ID No. _____________________

valid until _______________________2. ____________________________

Personal Appearance and Presentationof Two (2) Identification Documents

attested by PCAB designated staff or

DTI Regional/Provincial Staff

_______________________________Signature over Printed Name/Position

DTI Office Address: _____________________________________________________Date: ____________________________


13/22

PCAB Form No. 204a

LIST OF LAND, BUILDING AND OTHER IMPROVEMENTS OWNED BY AND REGISTERED IN THENAME OF THE COMPANY AS OF THE BALANCE SHEET DATE

COMPLETEDESCRIPTION

(Type of land/buildingand area)

TCT/CCTNUMBER

LOCATION(St. #, Barangay,

Municipality/ City, Province)

ACQUISITIONCOST

ACQUISITIONDATE

May be reproduced if necessary Revised 03/31/04


_________________________________________Company Name


________________________________________Date Signed

CFY___________________


14/22

PCAB Form No. 204b

LIST OF DELIVERY AND TRANSPORTATION EQUIPMENT OWNED BY AND REGISTERED IN THENAME OF THE COMPANY ASOF THE BALANCE SHEET DATE

COMPLETE DESCRIPTION

A C Q U I S I T I O N BOOKVALUE

PlateNo.

ChassisNo.

EngineNo.

M.V. FileNo.

CR No. Date Cost

P P

T O T A L P P

LIST OF MACHINERIES/PLANTS AND OTHER CONSTRUCTION EQUIPMENT OWNED BY THECOMPANY AS OF THE BALANCE SHEET DATE

COMPLETE

DESCRIPTION

SERIAL NO. A C Q U I S I T I O N BOOK

VALUEDate Cost

P P

T O T A L P PMay be reproduced if necessary Revised 03/31/04


_________________________________________

Company Name


________________________________________Date Signed

CFY _________________


15/22

PCAB Form No. 209

SCHEDULE OF RECEIVABLES

To be accomplished if the applicant's receivable accounts (accounts/contracts & other receivable) exceed 20% of the total

networth/equity as of the latest audited balance sheet submitted in support of its application.

TYPES AMOUNT AGENAME/ADDRESS OF

DEBTOR/CLIENTS

Notes: * All receivable accounts must be substantiated by confirmation of debtors/clientsPlease use necessary sheets if necessary

Certified by:__________________ _________________ Authorized Managing Officer Certified Public Accountant

SCHEDULE OF INVENTORIES

To be accomplished if the applicant's inventory accounts exceed 20% of the total networth/equity as of the latest audited balance

sheet submitted in support of its application.

Types AMOUNTAge/DateAcquired

Intended Use or

Purpose forStoring

PhysicalCondition

Place ofStorage

Please use necessary sheets if necessary 03/31/04

Certified by:__________________ _________________ Authorized Managing Officer Certified Public Accountant


16/22

PCAB Form 111-A

(For sole proprietorship)

Republic of the Philippines) s.s._______________________)

AFFIDAVIT

I, _______________________________, of legal age, Filipino, married/single with postal address at____________________________________, after having been sworn to in accordance with law, hereby deposeand say:

1. That I am the Proprietor/Authorized Managing Officer (AMO) of __________________________________________________________;

(Name of Firm)

2. That I appoint ____________________________, whose picture and signature appear below, to transactbusiness with PCAB; i.e, present for pre-screening my application for contractors license or anyapplication related thereto, file/follow-up, submit documents, receive notices/license in connection with thesaid application and the like.

______________________________(Signature over Printed Name of representative )

______________________________

______________________________COMPLETE HOME /MAILING ADDRESS

3. That I am aware that I am responsible/liable for any or all acts/representation made by my representativein connection with the functions stated herein.

4. That I undertake to notify PCAB in the event that this appointment is modified, amended or revoked.

_____________________________AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ____________, 20___, affiant exhibited his/herCommunity Tax Certificate No. _______________ issued at ___________ on ___________________.

Doc No. __________Page No. _________

Book No. _________Series of _________

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytimeyou transact with PCAB)

Passport size

Picture of

Representative

Notary PublicUntil December 200 ___


17/22

PCAB Form 111-B

(For corporation.,partnership,cooperative joint venture or consortium)

Republic of the Philippines) s.s._______________________)

AFFIDAVIT

I, _______________________________, of legal age, Filipino, married/single with postal address at

____________________________________, after having been sworn to in accordance with law, hereby deposeand say:

1. That I am the Authorized Managing Officer (AMO) of __________ ________________________________________;

(Name of firm)

2. That the abovestated firm had duly appointed ____________________________, whose picture andsignature appear below, to transact business with PCAB; i.e, present for pre-screening its application forcontractors license or any application related thereto, file/follow-up, submit documents, receivenotices/license in connection with the said application and the like.

______________________________(Signature over Printed Name of representative )

______________________________

______________________________COMPLETE HOME /MAILING ADDRESS

3. That we are aware that we are responsible/liable for any or all acts/representation made by the aboverepresentative in connection with the functions stated herein.

4. That the firm undertakes to notify PCAB in the event that this appointment is modified, amended or

revoked.

____________________________________AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ______________, 20__ affiant exhibited his/herCommunity Tax Certificate No. _______________ issued at ___________ on ___________________.

Doc No. __________Page No. _________Book No. _________Series of _________

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentationeverytime you transact with PCAB)

Passport size

Picture of

Representative



18/22

ARC Form 601

Application for REGISTRATION AND CLASSIFICATIONOF CONTRACTOR FOR GOVERNMENT INFRASTRUCTURE PROJECTS

with the Philippine Contractors Accreditation Board

In behalf of____________________________________________________________

(Name of Firm)a contractor duly licensed with the Philippine Contractors Accreditation Board. I hereby request for registrationpursuant to the implementing Rules and Regulations of PD 1594, as amended.

I hereby certify that the information and documents contained in this application are trueand correct of my own personal knowledge. I am fully aware that I shall be held personallyliable for any misrepresentation that may be found herein.

____________________________________

Authorized Managing Officer(Signature over Printed Name)

Republic of the Philippines}_______________________} s.s.

SUBSCRIBED AND SWORN to before me this _______ day of ___________________ 200 ___ at___________________________________ affiant exhibited to me his Community Tax CertificateNo. ______________ issued at _________________________ on ________________ 200 ____.

Doc. No. :

Page No. :Book No. : NOTARY PUBLIC

Series of : Until December 31, 200 ___

The following documents and information are hereby submitted in support of thisregistration application:

]

Checklist of Registration Application:

1. General Information (PCAB Form No. 602). 2. List ofSingle Largest Contract completed by the contractor of each Project Kindbeing applied for (PCAB Form No. 603). 3. Copy of Contract Agreement listed in PCAB Form No. 603 of each Project Kindbeing applied for duly authenticated by the tendering agency or project owneror incase of subcontract by the prime/main contractor. 4. Copy of Certificate of Acceptance/Completion from Tendering Agency/ProjectOwner of each Contract Agreement submitted duly authenticated by the tenderingagency or project ownerorin case of subcontract by the prime/main contractor.

5.Copy of Certificate of Creditable Income Tax Withheld (Form1743.1/1743.750/2307),

stamped-received by BIR for each private contracts and sub-contracts.

NOTE: Application for registration and supporting documents must be submitted in a folder andsigned on each and every page by the Proprietor/Authorized Managing Officer.

Do not fill, for PCAB use only:

Total no. of pages submitted ________ Checklisted by: ___________________________________ (Signature over Printed Name)Remarks: __________________________________________________ _________________

__________________________________________________ (Date)

(Revised 032601_GSD)Note:Only citizens or entities with at least 75% Filipino equity may apply

Registration- Page 18 of 22


19/22

PCAB Form No. 602

GENERAL INFORMATION SHEETContractors Particulars

FIRM NAME:

OFFICE ADDRESS: TEL, NO.:

TYPE OF ORGANIZATION: Corporation Partnership Sole Proprietorship

EQUITY: Filipino: % Foreign: %

License Particulars

Contractors License No.: Date Issued: Last Renewal:CFY _____ - _____

Principal Classifications: Present Category:

Other Classification(s):_____________________________________________________________________

_____________________________________________________________________

Type of application for PCAB License amendment, if any: Ref. No.:

Government Registration Particulars

PRESENT REGISTRATION VALIDITY PERIOD, if applicable: from ____________

___ to ________________

APPLICATION APPLIED FOR: New Registration Re-registration Upgrading Additional Project Kind

SIZE RANGEPlease indicate if:

Small A, Small B,Medium A, Medium B,

Large A, Large B

KIND OF PROJECT(Please check)

____________________________________

______________________________________________________

GENERAL ENGINEERING GE-1 Road, Highway pavement, Railways, Airport horizontal structures, & Bridges

GE-2 Irrigation and Flood Control

GE-3 Dam, Reservoir, and Tunneling

GE-4 Water Supply

GE-5 Port, Harbor, and Offshore Engineering

________________________________________________________________________

GENERAL BUILDING GB-1 Building and Industrial Plant

GB-2 Sewerage and Sewage Treatment/Disposal Plant

GB-3 Water Treatment Plant and System

GB-4 Park, Playground, and Recreational Work

____________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________

SPECIALTY SP-1 Foundation Work

SP-2 Structural Steel Work

SP-3 Concrete Pre-casting and Pre-stressing

SP-4 Plumbing and Sanitary Work

SP-5 Electrical Work

SP-6 Mechanical Work

SP-7 Air-conditioning and Refrigeration Work

SP-8 Elevator and Escalator Work

SP-9 Fire Protection Work

SP-10 Waterproofing Work

SP-11 Painting Work

SP-12 Well Drilling Work

SP-13 Navigational Facilities

SP-14 Communications Facilities

CERTIFIED CORRECT BY:

_______________________________Authorized Managing Officer/ Proprietor

(Signature over Printed Name)



20/22

PCAB Form No. 603

TRACK RECORD FORM (Only complete form & supporting documents will be considered)

_________________________________________________________________________ __________________

Name of Firm License No.

SINGLE LARGEST CONTRACTS COMPLETEDFor________________________________________Project Kind applied for (e.g. Road, Building etc.)

I. CONTRACT

Project Title:

________________________________________________________

________________________________________________________

________________________________________________________

Project Location: ________________________________________________________

Project Owner:

________________________________________________________

Date of Contract: ___________________ Amount of Contract: P _________________

Name of Main Contractor or Joint Venture, if any: _________________________________

Percent (%) share of the applicant in the contract: ____________ %

II. ACCEPTANCEDate of Document:

________________________ Date Accepted: __________________

Name of Signatory:

_________________________ Position: _______________________

III.WITHHOLDING TAX (for subcontract and non-government contract)

Withholding agent: ________________________________________________________

Name of the withholding agent's signatory: _____________________________________

Received and Stamped by:

{ BIR { BANKRDO No._______________________ Name: ________________________

Address:

_______________________ Address: ______________________

_______________________________ _____________________________

Date: __________________________ Date: _________________________

INSTRUCTIONS:

1. Attach at the back of this form clear & legible copies of the following documents:

a) Contract agreement duly authenticated by the tendering agency/project owner/ prime contractor in

case of subcontract.

b) Letter or certificate of acceptance duly authenticated by the tendering agency/ project

owner/prime contractor in case of subcontract.c) Certificate of creditable income tax withheld of source (BIR Form 1743.1, 1743.750 or 2307) duly

stamped-received by the BIR or Bank Collecting Agent for subcontracts & non-government

or private contracts)

2. Submit only one track record for each project kind.

_______________________________________________

Authorized Managing Officer/Proprietor




21/22

PCAB Form 111-A(For sole proprietorship)

Republic of the Philippines) s.s._____________________)

AFFIDAVIT

I, _______________________________, of legal age, Filipino, married/single with postal address at____________________________________, after having been sworn to in accordance with law, hereby depose andsay:

5. That I am the Proprietor/Authorized Managing Officer (AMO) of __________________________________________________________;

(Name of Firm)

6. That I appoint ____________________________, whose picture and signature appear below, totransact business with PCAB; i.e, present for pre-screening my application for contractorslicense or any application related thereto, file/follow-up, submit documents, receivenotices/license in connection with the said application and the like.

______________________________(Signature over Printed Name)

_______________________________

_______ _______________________________ HOME /MAILING ADDRESS

7. That I am aware that I am responsible/liable for any or all acts/representation made by myrepresentative in connection with the functions stated herein.

8. That I undertake to notify PCAB in the event that this appointment is modified, amended orrevoked.

________________________ AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ____________, 20___, affiant exhibited his/herCommunity Tax Certificate No. _______________ issued at ___________ on ___________________.


(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentationeverytime you transact with PCAB)


Passport size

Picture ofRepresentative



22/22

PCAB Form 111-B

(For corporation.,partnership,cooperative joint ventue or consortium)

Republic of the Philippines) s.s._____________________)

AFFIDAVIT

I, _______________________________, of legal age, Filipino, married/single with postal address at____________________________________, after having been sworn to in accordance with law, hereby depose andsay:

1. That I am the Authorized Managing Officer (AMO) of __________ ________________________________________;

(Name of firm)

2. That the abovestated firm had duly appointed ____________________________, whose pictureand signature appear below, to transact business with PCAB; i.e, present for pre-screening itsapplication for contractors license or any application related thereto, file/follow-up, submitdocuments, receive notices/license in connection with the said application and the like.

______________________________


______________________________

______________________________HOME /MAILING ADDRESS

3. That we are aware that we are responsible/liable for any or all acts/representation made by theabove representative in connection with the functions stated herein.

4. That the firm undertakes to notify PCAB in the event that this appointment is modified, amendedor revoked.

________________________AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ______________, 20__ affiant exhibited his/herCommunity Tax Certificate No. _______________ issued at ___________ on ___________________.


(Note: Please submit original and one duplicate to PCAB. Keep another copy forpresentation everytime you transact with PCAB)

Passport size

Picture of

Representative
