As of July 31, 2014

DSWD-SB- PS-F-001: Application Form

Republic of the Philippines

Department of Social Welfare and Development

APPLICATION FOR AUTHORITY

TO CONDUCT FUND CAMPAIGN

Date: ___________________

Status of Application: Type of Applicant:

 New Application  Government Agency
 Renewal (pls. indicate previous issued  Central Office  GOCC
permit No. and Date) ________________  Attached Agency  State Universities/
______________________________  Regional Office Colleges
 NGO/CSO/Faith-based
Scope/Coverage: organization
 National  Person
 Regional (more than
1 city/municipality)

I. Identifying Information
1. Name of Person/Corporation/Organization/
Association
__________________________________
__________________________________
__________________________________
3. Agency Head
_________________________________
5. Telephone/Cell phone/Fax Numbers
_________________________________
7. Registration/Permit No:
71. SEC/CDA (or other applicable Government
Registration) No:
______________________________
7.2. DSWD Registration/License No.
______________________________
2. Business Address:
_____________________________________
_____________________________________
_____________________________________
_____________________________________
4. Position Title/Designation
____________________________________
6. E-mail Address
___________________________________
8. Date of Issuance of Registration/Permit
8.1 SEC/CDA (or other applicable Government
Registration) Issued
_______________________________
8.2. DSWD Registration/License Issued
______________________________

II. Project Proposal (Please attached accomplished DSWD-SB- PS-F-002: Project Proposal)

I hereby certify that the information on this application form is true and complete.

________________________________________________________________________
(Signature Over Printed Name of the Agency Head or Authorized Representative)

Note: Please use additional sheet/s, if necessary.

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