REPUBLIC OF THE PHILIPPINES

PASIG CITY Control Number

Business Permit and License Office

Application for Business Permit

Instruction : Please accomplish this Form completely and legibly.
Date of Application
Transaction Type: Mode of Payment: Transfer of:

NEW ADDITIONAL ANNUALLY QUARTERLY Ownership

Mayor's Permit No.
RENEWAL RETIREMENT SEMI-ANNUAL Location

Kind of Ownership:
Single Partnership Corporation Business Name
DTI / SEC / CDA Registration Number and Tax Identification Number (TIN) SSS Number
Date:

Taxpayer's Gender Female Male Mobile Number(s) Fax Number(s)

Name of Taxpayer:
for Single Prop >>>
For Individual - Last Name First Name Middle Name

For Corporation / Partnership:

Business / Trade Name

Address
MAIN Office Branch Office

Name of President / CEO and contact number: Name of Operations / General Manager and Name of HRM / Personnel Manager contact
contact number: number:

Business Address Telephone Number(s) E-mail Address

House No./ Bldg No.Building Name Unit Number Street Barangay Subdivision City/Municipality

Owner's / Officer's Residential Address

Telephone Number(s) E-mail Address

House No./ Bldg No.Building Name Unit Number Street Barangay Subdivision City/Municipality
Admin Office Common Area Parking Area
Business Area in Square Meters >>>>

Total Number of No. of Employees No. of No. of

Employees: Residing in Pasig : Female: Male: Number of Units: Commercial Residential

Total Number of Delivery Neon Non-Neon One Faced Double Faced

Trucks/Vans/Vehicles >>>>> Size of Signboard:

BUSINESS ACTIVITY / Capitalization Gross Receipts of Previous Years GROSS SALES / RECEIPTS for RENEWAL
LINE OF BUSINESS (New Business) per Audited Financial Statements (Based on the One-Year Operation)

Building Permit Number Date Issued Electrical Permit Number & Date PLUMBING: Number of
Water Closets
Occupancy No. / Tax Declaration No. Date Issued Mechanical Permit Number & Date

Monthly Rental
If place of business is being rented, please identify the following Lessor's Information:

Last Name First Name Middle Name

Lessor's Address: House No./Building No. Street Barangay

Subdivision City/Municipality

Tax Declaration Number(s) Presented Telephone and Fax Number(s) E-mail Address

Community Tax Certificate Number of Taxpayer: Date Issued Place Issued

Note for Corporations: Only responsible person (e.g. President, Manager, Accounting or Finance Officer,
and Corporate Secretary) should sign the Application Form. In case of liaison officer
or an authorized representative, he/she should present an authorization letter duly
signed by responsible person from the company.
I affirm that the information listed above are true and correct. I also undertake to allow any duly authorized inspectors from various offices
or departments of the City Government of Pasig as well as of the National Government agencies, to conduct lawful inspection and
verification inside the business premises during office hours. Violation of the foregoing condition shall mean suspension or revocation
of Business Permit. Any misdeclaration on the above information would mean suspension or revocation of Business Permit.

Printed Name and Signature of Applicant/Representative Position / Title

SUBSCRIBED AND SWORN to before me this ____ day of ____________ , 20__ at City of Pasig, affiant exhibiting to me his/her CTC stated above.
DOC. Number
PAGE Number
BOOK Number
Series of 20__

Recommending Approval: Schedule of Payments: Approved by:

Jan 2 - 20 First Quarter

Apr 1 - 20 Second
Officer-in-Charge, BPLO Quarter Hon. MARIA BELEN A. EUSEBIO
July 1 - 20 Third Quarter
Oct 1 - 20 Fourth City Mayor
Original Copy (White Color) for BPLO Category VISIT US AT: www.pasigcity.gov.ph