ICARE FORM (REVISED 2010)

Republic of the Philippines

Department of Finance
Bureau of Customs
1099 Manila

INTERIM CUSTOMS ACCREDITATION AND REGISTRATION (ICARE) UNIT

REVENUE COLLECTION MONITORING GROUP

APPLICATION FOR ACCREDITATION

PARTNERSHIP CORPORATION COOPERATIVE

NEW RENEWAL APPLICANT REPRESENTATIVE

NAME: ______________________________________________________________________________________
Surname First Name Middle Name

NAME OF FIRM :_______________________________________________________________________________

Head Office Address: ___________________________________________________________________________

No./Bldg. Street Barangay City/Province Zip Code
Year/s of Stay in the Premises:__________
Nature of Occupancy: ( ) Owned ( ) Leased ( ) Shared

Others:_______________

Warehouse Address :________________________________________________________________________

Year/s of Stay in the Premises:__________
Nature of Occupancy: ( ) Owned ( ) Leased ( ) Shared

Others:_______________

Branch Office Address:_________________________________________________________________________

Year/s of Stay in the Premises:_____________________________________
Nature of Occupancy: ( ) Owned ( ) Leased ( ) Shared

Others:________________

Telephone Number/s: ____________________________________________

Facsimile Number/s: _____________________________________________
Email Address: _________________________________________________
Company TIN: __________________________________________________

Previous Certificate of Accreditation No.:____________________________________________

PERSON MANAGING THE AFFAIRS OF THE FIRM:

Name: _______________________________________________________________
Designation: __________________________________________________________
Telephone Number/s: ___________________________________________________
Specimen Signature: ______________________________________________________

ATTACHMENTS
NEW APPLICATION RENEWAL OF ACCREDITATION
OTHER INFORMATION:

Nature of Business:_____________________________________________________
Main Line of Business: __________________________________________________
Secondary Line of Business:______________________________________________
Other Business Activities: ________________________________________________
List of Importable Items:
Commodity Volume (1 Year Pd.)
________________________________ ________________________________
________________________________ ________________________________
________________________________ ________________________________

Amount of Capital Invested: ______________________________________________

Interest in Other Business/Enterprise (if any)

Name of Firm Nature of Interest SEC Reg. No

__________________ ____________________ _________________
__________________ ____________________ _________________
__________________ ____________________ __________________

I hereby certify under oath that:

1. All information supplied in this application are true and correct to the best of my belief and
knowledge;
2. All documents submitted to support this application are genuine and true; and
3. Any false or misleading information supplied, or production of materially false or misleading
document to support the application shall be a ground for the appropriate criminal, civil and or
administrative action against me.

____________________________________
Signatory of Applicant / Authorized Signatory

PHOTO ____________________________________
Position
2” x 2”
____________________________________
Name of Applicant-Importer

SUBSCRIBED AND SWORN TO before me this ____th day of ______________2010 in ______________,

Philippines ; affiant exhibiting to me his / her Community Tax Certificate No. _____________________ issued in
_________________________on ____________________.

NOTARY PUBLIC
(Until December ___)
Doc. No.:
Page No.:
Book No.:
Series of: