REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE
Annex A-1

APPLICATION FOR ACCREDITATION AS CPE PROVIDER

(For Individual Applicant)
1. Full Name of Applicant: ___________________________________________________
2. Business Address: ________________________________________________________
_______________________________________________________________________
3. Telephone Number: ___________________
Fax Number: __________________
4. Email Address:
___________________
Mobile Number:________________
5. PRC License Number / Roll of Attorney Number (if any): _________________________
6. Educational Background:
A. University or Equivalent
Name of School
Period of Attendance

Course / Degree

Certification, Awards or
Distinctions Received

B. Post-Graduate Studies
Name of School
Period of Attendance

Course / Degree

Certification, Awards or
Distinctions Received

C. Short Courses / Conferences / Other Programs or Specialized Training

Name of School
Period of Attendance
Course / Degree
Certification, Awards or
Distinctions Received

D. List of significant publications in the field of taxation

E. Membership in Professional Organizations / Honor / Civic Societies

7. Professional Background:
Name / Address of
Organization

Nature of Business

Job Title / Principal

Area of Professional
Work

8. Training course on taxation previously organized:

Course Title
Venue

Period of Engagement /
Number of Years in the
Practice of Taxation

Date

9. Required Attachments:
(A) Department of Trade and Industry registration papers;
(B) Proposed program of activities the content of which must relate to updates in taxation
and other pertinent administrative and court issuances relating to the practice of
taxations;
(C) List of pool of resource persons, speakers, or lecturers, with brief write-up on the
technical competence and training experience of each speaker in the field of taxation.
10. Applicant shall pay a non-refundable application fee of Five Thousand Pesos (P5,000.00)
upon the filing of this application form, and shall comply with the requirements of
accreditation as prescribed under RMO No. 39-2010. Applicant agrees to submit
additional documentary requirements as may be required by the RNAB.
___________________________________
Printed Name / Signature of the Applicant

__________________
Date