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  • First Name Middle Name Last Name: For Accounting Firms/Bookkeepers Only

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    This document is a declaration of gross receipts form that must be filled out by businesses operating in Iloilo City. It requests information such as the business name and address, number of employees, vaccination status, monthly gross sales by month, and preferred payment schedule. The business owner must sign an oath attesting that the information provided is true and correct. City officials will then verify required documents before recommending approval.

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    Original Title

    DGR-Revised-2021

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    This document is a declaration of gross receipts form that must be filled out by businesses operating in Iloilo City. It requests information such as the business name and address, number of employees, vaccination status, monthly gross sales by month, and preferred payment schedule. The business owner must sign an oath attesting that the information provided is true and correct. City officials will then verify required documents before recommending approval.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    3 views1 page

    First Name Middle Name Last Name: For Accounting Firms/Bookkeepers Only

    Uploaded by

    mac mac
    This document is a declaration of gross receipts form that must be filled out by businesses operating in Iloilo City. It requests information such as the business name and address, number of employees, vaccination status, monthly gross sales by month, and preferred payment schedule. The business owner must sign an oath attesting that the information provided is true and correct. City officials will then verify required documents before recommending approval.

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    © All Rights Reserved
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    of 1

    Date: _____/_____/20___

    DECLARATION OF GROSS RECEIPTS

    Account Number E – mail Address

    First Name Middle Name Last Name


    Business/Trade Name
    Business Address
    Business Tel. No. Business Mobile No.
    No. of Employees: Male: Female: Total:
    Employees  Fully Vaccinated Safety Seal  With Safety Seal
    Vaccination  Partially Vaccinated Certification:  Without Safety Seal
    Status:  Unvaccinated  Not Applicable
    For Accounting Firms/Bookkeepers Only
    Name of Accounting Firm/Bookkeeper Contact No.
    Name of Contact Person Contact No.

    Breakdown of Monthly Gross Sales or Receipts for CY 20___(for RENEWAL)

    Line of Business
    MONTH

    January
    February
    March
    April
    May
    June
    July
    August
    September
    October
    November
    December
    PHP PHP PHP PHP PHP

    Please check box of desired mode of payment: Annual Semi-Annual Quarterly

    Oath of Undertaking

    I DECLARE UNDER PENALTY OF PERJURY that all information in this application are true and correct based on my personal knowledge and authentic
    records submitted to the Investment Services Business Permits/License Division. Any false or misleading information supplied, or production of
    fake/falsified documents shall be grounds for appropriate legal action against me and automatically revokes permit. I hereby agree that all personal
    (as defined under the Data Privacy Law of 2012 and its implementing Rules and Regulation) and account transaction information or records with
    the Iloilo City Government may be processed, profiled or shared to requesting parties or for the purpose of any court, legal process, examination,
    inquiry and audit or investigation of any authority.

    __________________________________________________ ______________________________
    Signature over printed name (Owner/Representative) Position / Title

    This space is for BPLO personnel use only


    VERIFICATION OF DOCUMENTS
    Description Issuing Office / Agency Date Issued Remarks
    Barangay Clearance Brgy. __________________________
    Fire Safety Inspection Certificate Bureau of Fire Protection
    CCTV Certificate of Compliance CCTV Council

    Verified by: Approval Recommended by:

    _____________________________ _____________________________

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