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  • 7/28/2019 BPLO Forms

    1/6

    DEED OF UNDERTAKING/WAIVER

    NEW

    RENEWAL

    ADDITIONAL

    QUARTERLY

    SEMI-ANNUALY

    ANNUALY

    BUSINESS TRADE NAME TEL. NO.

    MAYORS PERMIT NO.

    DATE

    BUSINESS ADDRESS

    NAME OF TAXPAYER

    ADDRESS OF TAXPAYERS HOUSE NO. STREET NAME BARANGAY CITY/MUNICIPALITY

    NAME OF PRESIDENT / CEO / MANAGER

    COMMUNITY TAX CERTIFICATE NO.:

    SSS NO.:

    DATE ISSUED:

    CITY GOVERNMENT OF VALENZUELA

    TIN NO.:

    PLACE ISSUED:

    (INDIVIDUAL OR CORPORATE)

    IF TRANSFER OF OWNERSHIP

    FROM WHOM ACQUIRED:

    DELIVERY TRUCKS/VANS/VEHICLES

    NO. OF UNITS

    STORAGE OF FLAMMABLES ESTIMATED AREA USED IN BUSINESS

    NO. OF GALLONS:

    NAME OF OWNER:

    ADDRESS:

    KIND OF OWNERSHIP % OF ALIEN CAP INVESTMENT

    LOCATIONAL CLEARANCE NO.:

    SEC. REG. NO.:

    DATE OF ISSUE:

    DATE OF ISSUE:

    CERTIFICATE OF OCCUPANCY NO:

    BOI REG. NO.:

    DTI REG. NO.: DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    TO BE FILLED UP BY PROCESSOR/ASSESSOR

    TO BE FILLED UP BY NEW APPLICANT ONLY

    IF PLACE OF BUSINESS IS RENTED / NOT OWNED

    CDA REG. NO.:

    ENDORSEMENTS:

    OFFICE DATE ENDORSED DATE RELEASED OFFICE DATE ENDORSED DATE RELEASED

    ENGINEERING DEPARTMENT/

    BUILDING OFFICAL

    POLICE DEPARTMENT

    HEALTH DEPARTMENT

    FIRE/ELECTRICAL DEPARTMENT

    SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION

    RENT PER MONTH:

    ADMINISTRATOR: (If name of owner is not available)

    RENT START: (Month/Year)

    CODE LINE OF BUSINESS/ACTIVITIES GROSS SALES/RECEIPTS CAPITAL INVESTMENTSUBSCRIBED PAID-UP

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS FROM

    VALENZUELA

    SURNAME FIRST NAME MIDDLE INITIAL TEL. NO.

    HOUSE NO. STREET NAME BARANGAY

    Form VC BPO1

    Republic of the Philippines

    Metropolitan Manila

    APPROVED BY:

    CHIEF - BPLO

    CITY MAYOR

    SIGNATURE OF APPLICANT/REPR ESENTATIVE

    POSITION/TITLE

    1.

    2.

    3.

    REQUIREMENTS:

    RENEWAL:

    Barangay Clearance (2011)

    Community Tax Certificate (Cedula) 2011

    Previous permit and application

    1.

    2.

    3.

    NEW BUSINESS:

    Barangay Clearance

    Community Tax Certificate (Cedula)

    Sketch of Business Location

    All other requirements required by law, ordinance and rules

    are subject to Pos-Audit process.

    TAXPAYERS COPY

    I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

    As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all therequirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of

    the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirementsand in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation ofmy business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents

    and purposes.

    IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

    SHERWIN T. GATCHALIAN

  • 7/28/2019 BPLO Forms

    2/6

    DEED OF UNDERTAKING/WAIVER

    NEW

    RENEWAL

    ADDITIONAL

    QUARTERLY

    SEMI-ANNUALY

    ANNUALY

    BUSINESS TRADE NAME TEL. NO.

    MAYORS PERMIT NO.

    DATE

    BUSINESS ADDRESS

    NAME OF TAXPAYER

    ADDRESS OF TAXPAYERS HOUSE NO. STREET NAME BARANGAY CITY/MUNICIPALITY

    NAME OF PRESIDENT / CEO / MANAGER

    COMMUNITY TAX CERTIFICATE NO.:

    SSS NO.:

    DATE ISSUED:

    CITY GOVERNMENT OF VALENZUELA

    TIN NO.:

    PLACE ISSUED:

    (INDIVIDUAL OR CORPORATE)

    IF TRANSFER OF OWNERSHIP

    FROM WHOM ACQUIRED:

    DELIVERY TRUCKS/VANS/VEHICLES

    NO. OF UNITS

    STORAGE OF FLAMMABLES ESTIMATED AREA USED IN BUSINESS

    NO. OF GALLONS:

    NAME OF OWNER:

    ADDRESS:

    KIND OF OWNERSHIP % OF ALIEN CAP INVESTMENT

    LOCATIONAL CLEARANCE NO.:

    SEC. REG. NO.:

    DATE OF ISSUE:

    DATE OF ISSUE:

    CERTIFICATE OF OCCUPANCY NO:

    BOI REG. NO.:

    DTI REG. NO.: DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    TO BE FILLED UP BY PROCESSOR/ASSESSOR

    TO BE FILLED UP BY NEW APPLICANT ONLY

    IF PLACE OF BUSINESS IS RENTED / NOT OWNED

    CDA REG. NO.:

    ENDORSEMENTS:

    OFFICE DATE ENDORSED DATE RELEASED OFFICE DATE ENDORSED DATE RELEASED

    ENGINEERING DEPARTMENT/

    BUILDING OFFICAL

    POLICE DEPARTMENT

    HEALTH DEPARTMENT

    FIRE/ELECTRICAL DEPARTMENT

    SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION

    RENT PER MONTH:

    ADMINISTRATOR: (If name of owner is not available)

    RENT START: (Month/Year)

    CODE LINE OF BUSINESS/ACTIVITIES GROSS SALES/RECEIPTS CAPITAL INVESTMENTSUBSCRIBED PAID-UP

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS FROM

    VALENZUELA

    SURNAME FIRST NAME MIDDLE INITIAL TEL. NO.

    HOUSE NO. STREET NAME BARANGAY

    Form VC BPO1

    Republic of the Philippines

    Metropolitan Manila

    APPROVED BY:

    CHIEF - BPLO

    CITY MAYOR

    SIGNATURE OF APPLICANT/REPR ESENTATIVE

    POSITION/TITLE

    1.

    2.

    3.

    REQUIREMENTS:

    RENEWAL:

    Barangay Clearance (2011)

    Community Tax Certificate (Cedula) 2011

    Previous permit and application

    1.

    2.

    3.

    NEW BUSINESS:

    Barangay Clearance

    Community Tax Certificate (Cedula)

    Sketch of Business Location

    All other requirements required by law, ordinance and rules

    are subject to Pos-Audit process.

    BPLO COPY

    I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

    As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all therequirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of

    the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirementsand in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation ofmy business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents

    and purposes.

    IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

    SHERWIN T. GATCHALIAN

  • 7/28/2019 BPLO Forms

    3/6

    DEED OF UNDERTAKING/WAIVER

    NEW

    RENEWAL

    ADDITIONAL

    QUARTERLY

    SEMI-ANNUALY

    ANNUALY

    BUSINESS TRADE NAME TEL. NO.

    MAYORS PERMIT NO.

    DATE

    BUSINESS ADDRESS

    NAME OF TAXPAYER

    ADDRESS OF TAXPAYERS HOUSE NO. STREET NAME BARANGAY CITY/MUNICIPALITY

    NAME OF PRESIDENT / CEO / MANAGER

    COMMUNITY TAX CERTIFICATE NO.:

    SSS NO.:

    DATE ISSUED:

    CITY GOVERNMENT OF VALENZUELA

    TIN NO.:

    PLACE ISSUED:

    (INDIVIDUAL OR CORPORATE)

    IF TRANSFER OF OWNERSHIP

    FROM WHOM ACQUIRED:

    DELIVERY TRUCKS/VANS/VEHICLES

    NO. OF UNITS

    STORAGE OF FLAMMABLES ESTIMATED AREA USED IN BUSINESS

    NO. OF GALLONS:

    NAME OF OWNER:

    ADDRESS:

    KIND OF OWNERSHIP % OF ALIEN CAP INVESTMENT

    LOCATIONAL CLEARANCE NO.:

    SEC. REG. NO.:

    DATE OF ISSUE:

    DATE OF ISSUE:

    CERTIFICATE OF OCCUPANCY NO:

    BOI REG. NO.:

    DTI REG. NO.: DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    TO BE FILLED UP BY PROCESSOR/ASSESSOR

    TO BE FILLED UP BY NEW APPLICANT ONLY

    IF PLACE OF BUSINESS IS RENTED / NOT OWNED

    CDA REG. NO.:

    ENDORSEMENTS:

    OFFICE DATE ENDORSED DATE RELEASED OFFICE DATE ENDORSED DATE RELEASED

    ENGINEERING DEPARTMENT/

    BUILDING OFFICAL

    POLICE DEPARTMENT

    HEALTH DEPARTMENT

    FIRE/ELECTRICAL DEPARTMENT

    SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION

    RENT PER MONTH:

    ADMINISTRATOR: (If name of owner is not available)

    RENT START: (Month/Year)

    CODE LINE OF BUSINESS/ACTIVITIES GROSS SALES/RECEIPTS CAPITAL INVESTMENTSUBSCRIBED PAID-UP

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS FROM

    VALENZUELA

    SURNAME FIRST NAME MIDDLE INITIAL TEL. NO.

    HOUSE NO. STREET NAME BARANGAY

    Form VC BPO1

    Republic of the Philippines

    Metropolitan Manila

    APPROVED BY:

    CHIEF - BPLO

    CITY MAYOR

    SIGNATURE OF APPLICANT/REPR ESENTATIVE

    POSITION/TITLE

    1.

    2.

    3.

    REQUIREMENTS:

    RENEWAL:

    Barangay Clearance (2011)

    Community Tax Certificate (Cedula) 2011

    Previous permit and application

    1.

    2.

    3.

    NEW BUSINESS:

    Barangay Clearance

    Community Tax Certificate (Cedula)

    Sketch of Business Location

    All other requirements required by law, ordinance and rules

    are subject to Pos-Audit process.

    TREASURERS COPY

    I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

    As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all therequirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of

    the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirementsand in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation ofmy business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents

    and purposes.

    IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

    SHERWIN T. GATCHALIAN

  • 7/28/2019 BPLO Forms

    4/6

    DEED OF UNDERTAKING/WAIVER

    NEW

    RENEWAL

    ADDITIONAL

    QUARTERLY

    SEMI-ANNUALY

    ANNUALY

    BUSINESS TRADE NAME TEL. NO.

    MAYORS PERMIT NO.

    DATE

    BUSINESS ADDRESS

    NAME OF TAXPAYER

    ADDRESS OF TAXPAYERS HOUSE NO. STREET NAME BARANGAY CITY/MUNICIPALITY

    NAME OF PRESIDENT / CEO / MANAGER

    COMMUNITY TAX CERTIFICATE NO.:

    SSS NO.:

    DATE ISSUED:

    CITY GOVERNMENT OF VALENZUELA

    TIN NO.:

    PLACE ISSUED:

    (INDIVIDUAL OR CORPORATE)

    IF TRANSFER OF OWNERSHIP

    FROM WHOM ACQUIRED:

    DELIVERY TRUCKS/VANS/VEHICLES

    NO. OF UNITS

    STORAGE OF FLAMMABLES ESTIMATED AREA USED IN BUSINESS

    NO. OF GALLONS:

    NAME OF OWNER:

    ADDRESS:

    KIND OF OWNERSHIP % OF ALIEN CAP INVESTMENT

    LOCATIONAL CLEARANCE NO.:

    SEC. REG. NO.:

    DATE OF ISSUE:

    DATE OF ISSUE:

    CERTIFICATE OF OCCUPANCY NO:

    BOI REG. NO.:

    DTI REG. NO.: DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    TO BE FILLED UP BY PROCESSOR/ASSESSOR

    TO BE FILLED UP BY NEW APPLICANT ONLY

    IF PLACE OF BUSINESS IS RENTED / NOT OWNED

    CDA REG. NO.:

    ENDORSEMENTS:

    OFFICE DATE ENDORSED DATE RELEASED OFFICE DATE ENDORSED DATE RELEASED

    ENGINEERING DEPARTMENT/

    BUILDING OFFICAL

    POLICE DEPARTMENT

    HEALTH DEPARTMENT

    FIRE/ELECTRICAL DEPARTMENT

    SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION

    RENT PER MONTH:

    ADMINISTRATOR: (If name of owner is not available)

    RENT START: (Month/Year)

    CODE LINE OF BUSINESS/ACTIVITIES GROSS SALES/RECEIPTS CAPITAL INVESTMENTSUBSCRIBED PAID-UP

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS FROM

    VALENZUELA

    SURNAME FIRST NAME MIDDLE INITIAL TEL. NO.

    HOUSE NO. STREET NAME BARANGAY

    Form VC BPO1

    Republic of the Philippines

    Metropolitan Manila

    APPROVED BY:

    CHIEF - BPLO

    CITY MAYOR

    SIGNATURE OF APPLICANT/REPR ESENTATIVE

    POSITION/TITLE

    1.

    2.

    3.

    REQUIREMENTS:

    RENEWAL:

    Barangay Clearance (2011)

    Community Tax Certificate (Cedula) 2011

    Previous permit and application

    1.

    2.

    3.

    NEW BUSINESS:

    Barangay Clearance

    Community Tax Certificate (Cedula)

    Sketch of Business Location

    All other requirements required by law, ordinance and rules

    are subject to Pos-Audit process.

    ENGINEERINGS COPY

    I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

    As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all therequirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of

    the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirementsand in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation ofmy business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents

    and purposes.

    IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

    SHERWIN T. GATCHALIAN

  • 7/28/2019 BPLO Forms

    5/6

    DEED OF UNDERTAKING/WAIVER

    NEW

    RENEWAL

    ADDITIONAL

    QUARTERLY

    SEMI-ANNUALY

    ANNUALY

    BUSINESS TRADE NAME TEL. NO.

    MAYORS PERMIT NO.

    DATE

    BUSINESS ADDRESS

    NAME OF TAXPAYER

    ADDRESS OF TAXPAYERS HOUSE NO. STREET NAME BARANGAY CITY/MUNICIPALITY

    NAME OF PRESIDENT / CEO / MANAGER

    COMMUNITY TAX CERTIFICATE NO.:

    SSS NO.:

    DATE ISSUED:

    CITY GOVERNMENT OF VALENZUELA

    TIN NO.:

    PLACE ISSUED:

    (INDIVIDUAL OR CORPORATE)

    IF TRANSFER OF OWNERSHIP

    FROM WHOM ACQUIRED:

    DELIVERY TRUCKS/VANS/VEHICLES

    NO. OF UNITS

    STORAGE OF FLAMMABLES ESTIMATED AREA USED IN BUSINESS

    NO. OF GALLONS:

    NAME OF OWNER:

    ADDRESS:

    KIND OF OWNERSHIP % OF ALIEN CAP INVESTMENT

    LOCATIONAL CLEARANCE NO.:

    SEC. REG. NO.:

    DATE OF ISSUE:

    DATE OF ISSUE:

    CERTIFICATE OF OCCUPANCY NO:

    BOI REG. NO.:

    DTI REG. NO.: DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    TO BE FILLED UP BY PROCESSOR/ASSESSOR

    TO BE FILLED UP BY NEW APPLICANT ONLY

    IF PLACE OF BUSINESS IS RENTED / NOT OWNED

    CDA REG. NO.:

    ENDORSEMENTS:

    OFFICE DATE ENDORSED DATE RELEASED OFFICE DATE ENDORSED DATE RELEASED

    ENGINEERING DEPARTMENT/

    BUILDING OFFICAL

    POLICE DEPARTMENT

    HEALTH DEPARTMENT

    FIRE/ELECTRICAL DEPARTMENT

    SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION

    RENT PER MONTH:

    ADMINISTRATOR: (If name of owner is not available)

    RENT START: (Month/Year)

    CODE LINE OF BUSINESS/ACTIVITIES GROSS SALES/RECEIPTS CAPITAL INVESTMENTSUBSCRIBED PAID-UP

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS FROM

    VALENZUELA

    SURNAME FIRST NAME MIDDLE INITIAL TEL. NO.

    HOUSE NO. STREET NAME BARANGAY

    Form VC BPO1

    Republic of the Philippines

    Metropolitan Manila

    APPROVED BY:

    CHIEF - BPLO

    CITY MAYOR

    SIGNATURE OF APPLICANT/REPR ESENTATIVE

    POSITION/TITLE

    1.

    2.

    3.

    REQUIREMENTS:

    RENEWAL:

    Barangay Clearance (2011)

    Community Tax Certificate (Cedula) 2011

    Previous permit and application

    1.

    2.

    3.

    NEW BUSINESS:

    Barangay Clearance

    Community Tax Certificate (Cedula)

    Sketch of Business Location

    All other requirements required by law, ordinance and rules

    are subject to Pos-Audit process.

    HEALTH OFFICE COPY

    I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

    As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all therequirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of

    the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirementsand in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation ofmy business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents

    and purposes.

    IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

    SHERWIN T. GATCHALIAN

  • 7/28/2019 BPLO Forms

    6/6

    DEED OF UNDERTAKING/WAIVER

    NEW

    RENEWAL

    ADDITIONAL

    QUARTERLY

    SEMI-ANNUALY

    ANNUALY

    BUSINESS TRADE NAME TEL. NO.

    MAYORS PERMIT NO.

    DATE

    BUSINESS ADDRESS

    NAME OF TAXPAYER

    ADDRESS OF TAXPAYERS HOUSE NO. STREET NAME BARANGAY CITY/MUNICIPALITY

    NAME OF PRESIDENT / CEO / MANAGER

    COMMUNITY TAX CERTIFICATE NO.:

    SSS NO.:

    DATE ISSUED:

    CITY GOVERNMENT OF VALENZUELA

    TIN NO.:

    PLACE ISSUED:

    (INDIVIDUAL OR CORPORATE)

    IF TRANSFER OF OWNERSHIP

    FROM WHOM ACQUIRED:

    DELIVERY TRUCKS/VANS/VEHICLES

    NO. OF UNITS

    STORAGE OF FLAMMABLES ESTIMATED AREA USED IN BUSINESS

    NO. OF GALLONS:

    NAME OF OWNER:

    ADDRESS:

    KIND OF OWNERSHIP % OF ALIEN CAP INVESTMENT

    LOCATIONAL CLEARANCE NO.:

    SEC. REG. NO.:

    DATE OF ISSUE:

    DATE OF ISSUE:

    CERTIFICATE OF OCCUPANCY NO:

    BOI REG. NO.:

    DTI REG. NO.: DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    DATE OF ISSUE:

    TO BE FILLED UP BY PROCESSOR/ASSESSOR

    TO BE FILLED UP BY NEW APPLICANT ONLY

    IF PLACE OF BUSINESS IS RENTED / NOT OWNED

    CDA REG. NO.:

    ENDORSEMENTS:

    OFFICE DATE ENDORSED DATE RELEASED OFFICE DATE ENDORSED DATE RELEASED

    ENGINEERING DEPARTMENT/

    BUILDING OFFICAL

    POLICE DEPARTMENT

    HEALTH DEPARTMENT

    FIRE/ELECTRICAL DEPARTMENT

    SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION

    RENT PER MONTH:

    ADMINISTRATOR: (If name of owner is not available)

    RENT START: (Month/Year)

    CODE LINE OF BUSINESS/ACTIVITIES GROSS SALES/RECEIPTS CAPITAL INVESTMENTSUBSCRIBED PAID-UP

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS

    TOTAL NO. OF

    EMPLOYEES/

    WORKERS FROM

    VALENZUELA

    SURNAME FIRST NAME MIDDLE INITIAL TEL. NO.

    HOUSE NO. STREET NAME BARANGAY

    Form VC BPO1

    Republic of the Philippines

    Metropolitan Manila

    APPROVED BY:

    CHIEF - BPLO

    CITY MAYOR

    SIGNATURE OF APPLICANT/REPR ESENTATIVE

    POSITION/TITLE

    1.

    2.

    3.

    REQUIREMENTS:

    RENEWAL:

    Barangay Clearance (2011)

    Community Tax Certificate (Cedula) 2011

    Previous permit and application

    1.

    2.

    3.

    NEW BUSINESS:

    Barangay Clearance

    Community Tax Certificate (Cedula)

    Sketch of Business Location

    All other requirements required by law, ordinance and rules

    are subject to Pos-Audit process.

    I, , of legal age, Filipino and a resident of Valenzuela City, after having duly sworn to in accordance with law, avers that:

    As an applicant for a business permit/license for the City of Valenzuela and as a law abiding citizen and taxpayer thereof, I undertake to comply with all therequirements for the issuance of a business permit and license as required by law or City Ordinance. I further undertake to allow any duly authorized inspectors of

    the City Government to conduct ocular inspection of my establishment to ensure faithful compliance to any regulatory measures and post inspection requirementsand in case of violation or non-compliance thereof it will result in the closure of the business establishment without need of notice, Executive Order and revocation ofmy business permit. I executed this undertaking and waiver to attest to the truth and veracity of the foregoing based on personal knowledge and for all legal intents

    and purposes.

    IN WITNESS WHEREOF, I have hereunto set my hand this day of at Valenzuela City, Philippines

    SHERWIN T. GATCHALIAN