Appendices

Appendix A- Management Requirements

Pag-Ibig
BIR Form No.
Republika ng
Applicatio
PilipinasKagawaran ng n of
1903 January 2000 (ENCS)
Pananalapi
Kawanihan ng RentasInternas Registratio
For Corporations / Partnerships (Taxable / Non-Taxable),
n
Including GAIs and LGUs New TIN to be issued, if applicable (To
be filled up by BIR)

BIR
PhilHealth

SSS
 Republic of the Philippines
SOCIAL SECURITY SYSTEM EMPLOYER ID NUMBER

EMPLOYER REGISTRATION
cov -01228 (12-2015)
THIS FORM MAY BE REPRODUCED AND IS NOT FOR SALE. THIS CAN ALSO BE DOWNLOADED THRU THE SSS WEBSITE AT www.sss.gov.ph.
PLEASE READ THE INSTRUCTIONS AND REMINDERS AT THE BACK BEFORE FILLING OUT THIS FORM. PRINT ALL INFORMATION IN CAPITAL
LETTERS AND USE BLACK INK ONLY.
PART 1 - TO BE FILLED OUT BY THE EMPLOYER
TYPE OF EMPLOYER Business Household
A. FOR BUSINESS EMPLOYER
BUSINESS NAME TAX
IDENTIFICATI NUMBER
ON
BUSINESS ADDRESS (RM.FLR IUNIT NO. & BLDG NAME) (HOUSE/LOT & BLK NO,) (STREET NAME)

(SUBDIVISION) (BARANGAY/DISTRICT/LOCAUTY) (CITY/MUNICIPALITY) (PROVINCE) Z CODE

I
P

FOREIGN ADDRESS (IF APPLICABLE) COUNTRY

TELEPHO NUMBER E-MAIL ADDRESS WEBSITE

NE
START OF OPERATION NUMBER OF EMPLOYEES NATURE OF LEGAL PERSONALITY
(MMODYYYY BUSINESS Single Proprietorship Corporation C]
) Partnership C] Cooperative
NAME OF OWNER/MANAGING POSITION TITLE
PARTNER/PRESIDENT/CHAIRMAN/CORPORATE SECRETARY
(LAST NAME) (FIRST NAME) (MIDDLE NAME) (SUFFIX)
WITH PARENT COMPANY? YES, Indicate Name of Parent Company and ER ID No

B. FOR HOUSEHOLD EMPLOYER of FAMILY DRIVER'S

NAME (LAST NAME) (FIRST NAME) (MIDDLE NAME) (SUFFIX)

ADDRESS (RM FLR.nJNlT NO. & BLDG. NAME) (HOUSE,tOT& BLK. NO.) (STREET NAME) (SUBDIVISION)

(BARANGAY/DISTRICT,'LOCALITY) (CITY/MUNICIPALITY) (PROVINCE) Z COD E-MAIL ADDRESS

I E
P

TELEPHO NUMBER MOBILE/CELLPHONE NUMBER NUMBER OF TAX IDENTIFICATI NUMB

NE NO.) EMPLOYEES ON ER
C. CERTIFICATION (FOR BUSINESS/HOUSEHOLD EMPLOYER)
I certify that the information provided in this form are true and correct.

FOR BUSINESSEMPLOYER

PART 11 - TO BE FILLED OUT BY SSS

 BUSINESS CODE SCREENED/RECEIVED/PROCESSED BY REVIEWED/DATA CONTROLLED BY

SIGNATURE OVER PRINTED NAME DATE & TIME SIGNATURE OVER PRINTED NAME DATE &
TIME
INSTRUCTIONS
1. Fill out this form in two (2) copies and accomplish appropriate parts as follows:
For Business Employer Part I-A
For Household Employer of family driver/s Part
2 In filling out the box for Tax Identification Number (TIN) in Part I-A of the form, please fill out as follows:
Business TIN, if business employer
Personal TIN, if household employer
3. For the "Start of Operation" and "Number of Employees" boxes, fill out the required data, as follows:

Start of Operation exact date Of start of business operation/date of employment of family driver
Number of Employees actual number of employees upon registration with SSS, if any
4 Always indicate "NIA" or "Not Applicable", if the required data is not applicable.

5. Always affix initials on all erasures/alterations on this form

6. Present valid identification cards/documents, Refer to attached "List of Filer'S Valid Identification (ID) Cards/Documents"
7. Write the Employer ID Number and Employer Name in all pages of all identification cards/documents.
8. Submit this form to the nearest SSS branch office with the supporting documents. Refer to the attached List of
Documentary Requirements. 9 This form shall be signed by the following authorized signatories:
9.1 For Business Employer 92 For Household Employer of Family Driver/s
LEGAL PERSONALITY AUTHORIZED SIGNATORY SUPPORTING DOCUMENT/S
A. Single Proprietorship Owner or, in his/her absence, any Any of the following:
representative with valid Special Power 1. Certificate of Registration of
of Attorney (SPA) Business Name from the
Department of Trade and Industry
(DTI)
2. Business Permit from the
Municipal Office
B. Partnership Managing Partner Approved Articles of Partnership from
Incorporation from Securities and
Exchange
Commission (SEC)
C Corporation Including President, Chairman or Corporate Approved Articles of Incorporation
Secretary from SEC
nonstock/non-profit
corporations The designated Philippine 1 Approved Articles of Incorporation
Foreign-owned corporation representative as shown in the SEC from
registration
SEC; and
2. License to Transact Business in the
Manning agency with foreign Philippines from SEC
President, Chairman or Corporate
principal Secretary

D. Cooperative
Manpower service cooperative
10, Report all your employees for SS coverage within thirty (30) days from the date of their employment by submitting an
accomplished "Employment
2 Agency Agreement between the
Chairman or Corporate Secretary
Chairman or Corporate Secretary
1 Approved
Articles of Incorporation from
SEC; and
manning agency and foreign
principal
Approved Articles of Cooperation
from the Cooperative Development
Authority (CDA)
1. Approved Articles of Cooperation
from
CDA; and
2. Accreditation from the
Department of Labor and
Employment (DOLE)

Report" (SS Form R-IA) to the nearest SSS branch office. Please be reminded that failure to report your employee/s
within the prescribed period shall render you liable for damages equivalent to the benefits to which said employee/s would
have been entitled in case of any contingency had the employee/s been reported on time. (Sec. 24 of R.A. 8282),

51. Separation of your employee/s should be reported by submitting an accomplished "Employment Report" form.

REMINDERS
'1 Always use your correct Employer Number in all your transactions with SSS

2 Notify the nearest SSS branch office using the "Employer Data Change Request" (SS Form R-8) to update your data/records
with the SSS. This will expedite your transactions with SSS and avoid the possibility of being billed of unpaid contributions
in case of temporary suspension or cessation of business operation
4. Verification of status may be made thru the SSS website at mm.sss.gov.ph or contact our Call Center at 920-6446 up to 55
or 917-7777.
 LIST OF FILER'S VALID IDENTIFICATION (ID) CARDS/DOCUMENTS
EMPLOYER REGISTRATION FORM (SS FORM R-1)

FILED BY
IDENTIFICATION REQUIREMENTS BUSINESS/HOUSEHOLD
BUSINESS EMPLOYER EMPLOYER'S
REPRESENTATIVE
1 One (1) Primary ID card/document of the (Present the original.) (Present the original &
authorized signatory of the SS Form R-1; submit the
OR
photocopy.)
Two (2) Secondary ID cards/documents
of the of the SS Form
R-1.
[both with signature and at least one (1)
with photo]
2 One (1) Primary ID card/document of (Present the original &
, the representative of the authorized submit the photocopy.)
signatory of the registration form, OR
Two (2) Secondary ID cards/documents of
cepcegenta!lye of the authorized signatory
of the SS
Form R-1.
3 Authorization Letter
. Submit the oriinal.
Note: If filed personally by the Household Employer, no ID card/document is required.
A. Primary ID Cards/Documents
1. Driver's License
2. Passport
3. Professional Regulation Commission (PRC) Card
4. Seaman's Book (Seafarer's Identification & Record Book)
5. Social Security (SS) Card
6. Unified Multi-Purpose ID (UMID) Card

B. Secondary ID Cards/Documents
1. Alien Certificate of Registration 12. ID Card issued by professional association
2. Certificate from any of the following, recognized by PRC whichever is applicable: 13. Marriage
Contract/Marriage Certificate

> National Commission on Indigenous Peoples 14. Overseas Worker Welfare Administration (OWWA) Card

> National Commission on Muslim Filipinos 15. Pag-lBlG Member's Data Form or Transaction Card
3. Certificate of Licensure/Qualification Documents 16. Philippine Health Insurance Corporation
(PHIC) ID Card/ from Maritime Industry Authority Member's Data Record
4. Company ID Card 17. Police Clearance
5. Credit Card 18. Postal ID Card
6. Firearm License Card issued by Philippine 19. School ID Card
 National Police (PNP) 20. Seafarer's Registration Certificate issued by Philippine

7. Fishworker's License issued by Bureau of Fisheries Overseas Employment Administration (POEA)

and Aquatic Resources (BFAR) 21. Senior Citizen Card

8. Government Service Insurance System (GSIS) 22. Student Permit issued by Land Transportation
Card/Members Record/Certificate of Membership Office (LTO)
9. Health or Medical Card 23. Taxpayer's Identification Number (TIN) Card
10. Homeowners Association ID Card24. Voter's Identification Card/Affidavit]Certificate of Registration

11. ID Card issued by Local Government Units (LGUs)

(e.g., Barangay/Municipality/City)

DOLE
BWC-IP3-rev_2011
 Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No.

Registry of Establishment
EIN:

3
1. Name of Establishment
2. Address
Street City/Municipality Province

4. Telephone No.: Fax No. : Email Address:

5. Name of Manager / Owner

. TIN :

6. Nature of Business & Product Manufactured, Service rendered or Merchandise sold:

( Example Manufacturing -- Textile, Construction -- Building, Agriculture -- Production of Livestock, etc; Forestry -

Logging; Services -- Generation and Distribution of Electricity, Commerce - Lumber and Construction
Materials; Wholesale or Retail)

7. Number of Employees
Non-
Resident Below Below 18-30 Above
Total Filipinos Resident
Alien 15 1517 yrs yrs 30 yrs.
Alien
Male
Female
Grand Total
8. Name & Address of Labor Union, if any:
BLR Registration No.
9. Technical Information (Please Check / Enumerate) 9a. Machinery, Equipment and Other Devices in use:
Circular saw Machine Drill Press Boiler Pressure VesselInternal Combustion Engine Engine
Diesel Gasoline Others, Specify

9b. Materials Handling Equipment:

Power Trucks Hand Trucks Conveyors Forklif Cranes Others,

Specify 9c. Chemical or Substances Used or Handled:

10.If Branch unit, name of parent establishment:

Location
11.Current Capitalization
Total Assets:

12.Photocopy of DTI Certificate of Registration / Business Permit (pls. attach)

FOR RE-REGISTRATION ACCOMPLISH ALSO:

13.Past Application Number Date of Application

14.If Changing Name of Establishment, State Former Name;

15.If Changing Location, Give Past Address:

I hereby certify that the above information is true and correct.

Owner/President

Date Filed : Date Approved: Approved by:

(Regional Director or Assistant Regional

Director or Head of Field Office)

Fire Prevention
Republic of the Philippines
 Department of }nterior and Local Govemmerd BUREAU OF
FRE PROTECTION
(Region)
(DistricUProvinciaI Office)
(STATION)
(Station Address)

Number:

(Pre-Numbeæd)

FIRE SAFETY EVALUATION CLEARANCE

Date TO
WHOM IT MAY CONCERN:

By virtue of the provisions of RA 95140therwise known as the Fire Code of the Phihppines of 2008 the
application for FIRE SAFETY EVALUATION CLEARANCE for the

(Name 01 Building/Structure/Facility) be
constructed/renovated/aitered/modified)change Of occupancy located at owned by

(Address) (Name of Owner/Representative) is hereby granted FIRE SAFETY EVALUATION

CLEARANCE afer said building pians and other documents have been duly evaluated with the recommendations in
the Fire Safety Checklist (FSC) be adopted in compliance with the requirements of the Fire Code of the Philippines of
2008 (RA 9514) and its Implementing Rules and Regulations.

This clearance is issued on condition that alf Fire Code provisions now adopted, or shall thereafer be adopted,
shall continue to be complied With until completion of construction.

VIOtation Of Fire Code provisions shall ipso facto cause this clearance null and void. and shall hold
the owner of the building liable to the penalties provided for by the said Fire Code (RA 9514).

Fire Code Fees: RECOMMEND APPROVAL:

Amount Paid:
O.R. Number:

Date:

CHIEF, FSES
APPROVED:

CITY/MUNiClPAL FIRE MARSHAL

NOTE: This Clearance is accompanied by Fire Safety Checklist and does not take the place ofany license
required by law and is not transferable. Any change or alteration in the design and specification during
construction shall tequire a new clearance.
"FIRE SAFETY IS OUR MAIN CONCERN"

Original (Applicant/()wner's copy)

Duplicate (BOIBPLO copy)
Triplicate (BFP copy)
Republic of the Philippines
Department of Interior and Local Government
BUREAU OF FIRE PROTECTION
(Region)
(District/Provinciai Office)
(STATION)
(Station Address)
Number:

(Pre-Numbered)
Contract of Mayor’s Permit
Barangay Clearance
Appendix B- Articles of Partnership
List of Table
List of figures
References
Appendix C- Curriculum Vitae