BAI-AHWD Form No.

1 (Revised September 2016)

Application No.: ___________________ Latest 1”x1” ID
Picture of
Republic of the Philippines Applicant/
Department of Agriculture Authorized
BUREAU OF ANIMAL INDUSTRY Representative
Diliman, Quezon City

APPLICATION FOR REGISTRATION

under Republic Act No. 8485 otherwise known as the Animal Welfare Act of 1998 as amended by RA 10631

____________________________________
Date

Name of Applicant ________________________________________________________________________________________________________________________________________________________________

Last Name First Name M.I.

Address ____________________________________________________________________________________________________________________________________________________________________________

Contact No/s _______________________________________________________________________________ TIN ___________________________________ Nationality________________________________

Nature of Business/Type of Animal Facility

[ ] Animal Boarding Facility [ ] Animal Shelter [ ] Poultry Farm [ ] Laboratory Animal [ ] Wildlife Rescue Center
[ ] Aviary [ ] Pet shop [ ] Cattle/Goat Farm [ ] Racetrack/Equestrian Establishment [ ] Zoo
[ ] Canine Facility/K9 Provider [ ] Crocodile Farm [ ] Monkey Farm [ ] Slaughterhouse/Poultry Dressing Plant
[ ] Cattery [ ] Grooming Facility [ ] Ostrich Farm [ ] Stock Farm/Stockyard/Stud Farm/Coral
[ ] Kennel [ ] Hog Farm [ ] Animal Pound [ ] Veterinary Clinic/Hospital
[ ] Others (Please specify):

Business/Trade Name ___________________________________________________________________________________________________________________________________________________________

Type of Business Organization [ ] Sole Proprietorship [ ] Partnership [ ] Corporation [ ] Others (Please specify) _______________________

Business Address _________________________________________________________________________________________________________________________________________________________________

Contact No/s ___________________________________________________ Email Address _________________________________________________________ TIN ___________________________________

Name of Veterinarian ____________________________________________________________________________________________________________________________________________________________

Last Name First Name M.I.

TIN_________________________________________________ PRC License No. ______________________ Valid Until __________________________________

PTR No. ________________________________ Issued on ____________________________ Issued at ______________________________________

Member of any Professional Organization/Association? [ ] Yes [ ] No

If Yes, Name/s of Professional Organization/Association _____________________________________________________________________________________________________________________

Has Attended Any Animal Welfare Seminar/Training? [ ] Yes [ ] No

If Yes, Name/s of Training/Seminar Attended

Training/Seminar Title Date Venue Organizer

___________________________________________________________ ____________________ __________________________ _____________________ ________________________________________________

___________________________________________________________ ____________________ __________________________ _____________________ ________________________________________________

_________________________________________________________
Applicant/Authorized Representative
(Printed Name and Signature)

SUBSCRIBED AND SWORN to before me, this ____________________ day of ____________________________________________________, 20____________________.

The affiant exhibited to me his/her Community Tax Certificate No. _____________________________________ issued at ________________________________________________ on

______________________________________, 20______.

Doc. No. ________________

Page No.________________
Book No. _______________
Documentary Stamp
Series of________________
Affixed Here
___________________________________________________________
Notary Public
______________________________________________
Authorized BAI representative/
RAWO

RECOMMENDING APPROVAL:
______________________________________________
Office

(To be filled-up by BAI-AHWD/DA-RAWO)

Registration Certificate No. _______________________ APPROVED:
Date Issued ___________________________________
Amount Paid___________________________________
Official Receipt No.______________________________
Date Issued____________________________________
Remarks______________________________________
[ ] New [ ] Renewal [ ] Amendment
 INSTRUCTIONS

I.WHERE TO APPLY

Registration forms (in triplicate) shall be secured from the BAI-Animal Health and Welfare Division (AHWD), Visayas Avenue,
Diliman, Quezon City or from any DA-Regional Field Offices. The accomplished form together with all supporting documents
shall be filed at the office of the Chief, BAI-AHWD for recording, evaluation, processing and assignment of registration number.

II.DOCUMENTS REQUIRED

_____________Mayor’s Permit for renewal registration (Photocopy)

_____________Business Name with BDT/SEC (if corporation) and Articles of Incorporation (Photocopy)
_____________ID picture of the Owner/General Manager and Veterinarian
_____________Establishment’s/Facility’s Veterinarian PRC License, PTR and S2 License from PDEA, if applicable (Photocopy)
_____________Notarized Employment Contract/MOA of the Veterinarian, when applicable (Photocopy)
_____________Notarized valid Contract of Lease of the space/building occupied (Photocopy)
_____________Location Plan/Sketch of the Establishment
_____________Certification/s that the owner/veterinarian has attended seminar/s on Animal Welfare
_____________Environmental Clearance Certificate (ECC) from the Department of Environment and Natural Resources (DENR)
_____________Appropriate permits issued by DENR for wildlife facilities

III.SCHEDULE OF FEES

ESTABLISHMENT INITIAL RENEWAL

(1 year) (3 years)
Animal Boarding and Recreation Facility ₱ 300.00 ₱ 900.00
Animal Show (Television) ₱ 1,000.00 ₱ 3,000.00
Animal Show (Movie/Film) ₱ 5,000.00 ₱ 15,000.00
Aviary ₱ 500.00 ₱ 1,500.00
Canine Facility/Canine Security ₱ 300.00 ₱ 900.00
Cattery/Kennel/Laboratory Animal Facilities/Pet Shops ₱ 500.00 ₱ 1,500.00
Circus/Carnival/Animal Show ₱ 1,000.00 ₱ 3,000.00
Crocodile Farm ₱ 1,000.00 ₱ 3,000.00
Grooming Facility ₱ 300.00 ₱ 900.00
Hog/Poultry/Cattle/Goat Farm ₱ 1,000.00 ₱ 3,000.00
Monkey Farm ₱ 1,000.00 ₱ 3,000.00
Ostrich Farm ₱ 300.00 ₱ 900.00
Pounds/Shelters ₱ 200.00 ₱ 600.00
Racetrack/Equestrian Establishment ₱ 500.00 ₱ 1,500.00
Slaughterhouse/Poultry Dressing Plant ₱ 500.00 ₱ 1,500.00
Small Animal Show ₱ 500.00 ₱ 1,500.00
Stock Farm/Coral/Stockyard/Stud Farm ₱ 500.00 ₱ 1,500.00
Veterinary Hospital/Veterinary Clinic ₱ 300.00 ₱ 900.00
Wildlife Rescue Center ₱ 300.00 ₱ 900.00
Zoo ₱ 1,000.00 ₱ 3,000.00
Other related animal facilities ₱ 300.00 ₱ 900.00

SURCHARGE: Upon renewal, a surcharge of 50% of the amount due shall be levied on every expired registration certificate.

IV.DISPLAY OF REGISTRATION CERTIFICATE

Registration Certificate shall be displayed conspicuously in the place of business and must be readily visible to the public.