NEW TRANSFER OF LOCATION Republic of the Philippines

RENEWAL CORRECTION OF ENTRIES

ADDITIONAL SPECIAL PERMIT
Province of Agusan del Sur _____________
QUARTERLY MUNICIPALITY OF SAN FRANCISCO DATE
SEMI-ANNUAL
ANNUALLY

REQUIREMENTS
NEW BUSINESS REGISTRATION: RENEWAL APPLICATIONS:
1. Proof of business registration, incorporation, or legal personality 1. Basis for computing taxes, fees and charges (e.g Income Tax Returns);
(ie, DTI / SEC Cooperative Development Authority (CDA) registration): 2. Barangay Clearance; (Barangay)
Note: in certain cases like Sari-Sari Stores not using any or without 3. Landholding Certificate (Municipal Assessor’s Office);
business name the requirements of DTI / SEC registration may be 4. Sanitary Permit (Municipal Health Center / RHU);
dispense with during initial registration (see Act No. 3883) 5. Fire Safety Inspection Certificate (FSIC) (Bureau of Fire Protection Office);
2. Basis for computing taxes, fees and charges (e.g. business capitalization); 6. Solid Waste Certification (Municipal Planning Office);
3. Occupancy Permit, if required by national laws (e.g. Building Code) and local laws; 7. Building Inspection Certificate (Building Official).
4. Contract of Lease (if lessee);
5. Barangay Clearance; (Barangay)
6. Landholding Certificate (Municipal Assessor’s Office);
7. Sanitary Permit (Municipal Health Center / RHU);
8. Fire Safety Inspection Certificate (FSIC) (Bureau of Fire Protection Office);
9. Solid Waste Certification (Municipal Planning Office);
10. Police Clearance (Police Station); and
11. Zoning Certification (Municipal Planning Office).
All other requirements required by law, ordinance and rules are subject to Post-Audit process.
BUSINESS TRADE NAME TEL. NO. z

BUSINESS ADDRESS HOUSE NO. STREET NAME BARANGAY

NAME OF TAXPAYER SURNAME FIRST NAME MIDDLE INITIAL TEL. NO.

ADDRESS OF TAXP AYER HOUSE NO. STRET NAME BARANGAY CITY / MUNICIPALITY

DATE OF BIRTH PLACE OF BIRTH

NAME OF PRESIDENT / CEO / MANAGER TIN NO. EMAIL ADDRESS

COMMUNITY TAX CERTIFICATE NO.: DATE ISSUED: PLACE ISSUED:

(INDIVIDUAL OR CORPORATE)
BUSINESS ACTIVITY
CODE LINE OF BUSINESS CAPITALIZATION GROSS / SALES RECEIPTS (FOR RENEWAL) TOTAL NO. OF EMPLOYEES IN
ESTABLISHMENT:
(FOR NEW BUSINESS) ESSENTIAL NON-ESSENTIAL
TOTAL NO. OF EMPLOYEES
RESIDING WITHIN LGU:

DELIVERY TRUCKS/VANS/VEHICLES STORAGE OF FLAMMABLES BUSINESS AREA (IN SQ M..)

NO. OF UNITS NO. GALLONS:
KIND OF OWNERSHIP: DTI/SEC/CDA Registration No.:
COMMUNITY TAX CERTIFICATE (CTC) NUMBER: TAXPAYER IDENTIFICATION NUMBER (TIN):
Are you enjoying tax incentive from any Government Entity? Yes No If yes, please specify the entity.
NOTE: FILL-UP ONLY IF BUSINESS PLACE IS RENTED
LESSOR’S FULL NAME: LESSOR’S CONTACT NO. LESSOR’S EMAIL ADDRESS

LESSOR’S FULL ADDRESS RENT PER MONTH:

Oath of Undertaking:
1. That I will comply completely & religiously all existing provisions of laws, municipal ordinances, policies, rules & regulation governing
business operations in the municipality of San Francisco, Agusan del Sur within 30 days from release of my business permit;
2.That my Business Sales Records or Receipts and book of accounts will be presented anytime upon demand by Municipal Treasury
Personnel pursuant to Sec. 171 of RA 7160.;
3.That I absolutely authorized the Municipal Mayor thru the Chief of Police to close or padlock my business in case of default and failure
to pay my business and realty taxes, rentals fees and charges and other municipal impositions;
4.That I will voluntarily surrender my business license & permits to the Municipal Treasurer & License Office in case I will cease to operate
my business, at least three (3) days before its effectivity...

______________________________________________________________________
SIGNATURE OF APPLICANT / REPRESENTATIVE

______________________________________________________
POSITION / TITLE
LGU SECTION (Do Not Fill Up This Section) Verification of Documents
DESCRIPTION OFFICE / AGENCY YES NO NOT NEEDED
Occupancy Permit (For New) Office of the Building Official
Barangay Clearance (For New and Renewal) Barangay
Sanitary Permit/Health Clearance (For New and Renewal) Municipal Health Office
Municipal Environmental Certificate (For New and Renewal) Municipal Environment and Natural Resources Office
Valid Fire Safety Inspection Certificate (For New and Renewal) Bureau of Fire Protection
Zoning Certification Municipal Planning Office
Landholding Certification Municipal Assessor’s Office

DENIED / DISAPPROVAL
You have been cited in a list of those establishment with unsettled obligations / or requirements with the following office/s:
GOVERNMENT AGENCY
BARANGAY MASSO
MHO BFP
MPDC BUILDING OFFICIAL

You are hereby required to submit the above-mentioned requirements. Otherwise, we will have no recourse but to have your issued Business Permit deemed
revoke or not renew your business permit for the current year in accordance with the applicable law, ordinance, rules and regulations.
Received by: _______________________________ Denied/Disapproved by: ________________________
Designation: _______________________________ Designation: _________________________
Date & Time: ______________________________ Date & Time: _________________________