PCAB Form No.

201

APPLICATION FOR RENEWAL OF CONTRACTOR'S LICENSE with the PHILIPPINE CONTRACTOR'S ACCREDITATION BOARD
The following pertinent documents and information are to be submitted in support of the license application of said firm:

Checklist for Renewal Application A. Legal

[ ] 1. General Information (PCAB Form Nos. 201a and 202); [ ] 1.1 Certified true copy of subsequent amendments (if any) to Articles of Incorporation and/or By-Laws in case of Corporate or Partnership applicant; [ ] 1.2 For change in address only: Business Permit from the municipality/city where the principal office of the applicant is located, or any other official document showing the new office address of the applicant.;

B. Financial

[ ] 2. Certified true copy of the Annual Income Tax Return filed with the BIR for the taxable year immediately preceding the filing of renewal application; [ ] 3. Financial Statements (duly audited and signed on every page by a PRC-BOA accredited external auditor) as of the end of the taxable year immediately preceding the filing of application duly filed with the BIR and a diskette /CD (compact disc) containing the firms Audited Balance Sheet & Income Statement in the prescribed template (PCAB Financial Statement downloadable from the DTI Website at www.dti.gov.ph together with the pertinent application forms) Documents in support of new acquisition: [ ] 3.1 If increase is due to additional capital infusion
[ ] 3.1.1. Cash Original copy of Bank Certification/Bank statement of account certified by Bank Manager of cash deposits as of Balance Sheet date; Authorization to Depository Bank (PCAB Form No. 203a); [ ] 3.1.2 Land and Building - List of Land and Building/s owned by the company and registered in its name (PCAB Form No. 204a); Certified true copy of TCT including back page for newly acquired land and/or condominium which were not previously reported/submitted to PCAB. [ ] 3.1.3 Transportation & Construction Equipment - List of Construction and/or Transportation/Delivery Vehicles/Equipment/Machineries/Plants owned by the company and registered in its name, (PCAB Form No. 204b); Certified true copy by the LTO of the LTO Certificate of Registration and current Official Receipt of Registration of newly acquired registrable Construction and/or Transportation/ Delivery Vehicles/Equipment Certified true copy of Deed of Sale or sales invoices/official receipts for newly acquired non-registrable construction equipment/machineries/plants, or newly acquired construction equipment [ ] 3.1.4 Additional documents to be submitted only if applicant's Inventories and Receivables Accounts are more than 20% and 20% of Networth, respectively: [ ] 3.1.4.a Schedule of Inventories (PCAB Form 209); [ ] 3.1.4.b Schedule of Receivables. (PCAB Form 209); 3.2 If increase is due to appraisal of properties [ ] 3.2.1. Independent Appraisers Report

C. Experience of Firm D. Technical

[ ] 4. Authorization to BIR & other agencies (PCAB Form No. 203);

[ ] 5. Statement of Annual Value of Work Accomplished (PCAB Form 205); [ ] 6. List of STEs (PCAB Form No. 204) supported by applicable documents (listed below) for each STE;

For newly nominated STE/s:

[ ] 6.1 STE Affidavit/s (PCAB form 206) with a passport size picture/s of the new STE/s;

[ ] 6.2 [ ] 6.3 [ ] 6.4

[ ] 6.1.1 Certified true copy of valid PRC ID of STE as licensed professional or original Certification of Good Standing for those awaiting issuance of new or renewed PRC ID. [ ] 6.1.2 NBI clearance/s of new STE/s;

STE Affidavit/s of Construction Experience (PCAB Form 207); Personal Appearance Form duly accomplished and signed by the STE/s appearing before the designated officer of the PCAB or the nearest DTI regional/provincial office (PCAB Form No. 208) STE Affidavit/s (PCAB form 206);
[ ] 6.4.1 For STE/s below 60 years old: Certified true copy of the pertinent page of CCL (formerly SSS Form R-3) submitted to SSS for the quarter immediately preceding the filing of application;

For previously nominated STE/s:

[ ] 6.4.2 For STEs 60 years old and above: Certified true copy of Certificate of Income Tax Withheld on compensation (BIR Form 2316, formerly BIR W-2) for the taxable year year immediately preceding the filing of application issued by the firm to the employee and duly stamped received by BIR/ or accredited bank. Others: PCAB Response Form (self-addressed and with sufficient stamps affixed) NOTE: Original signature of Proprietor/AMO on each & every page of application forms including supporting documents (except item 6.3).

: Photocopies of documents in lieu, of certified true copies are accepted provided the original copies are presented for authentications.

DO NOT FILL (For PCAB use only) Total No. of Pages Submitted: _______ Checklisted by: _____________________________ [ ] Self-stamped envelopes * (no. ______ ) Name over Signature/Date Remarks: _________________________________ ________________________________________

_________________________________________
Revised 03/06/07

________________________________________

* One for each depository bank; one each for BIR, LTO, & LRA; and one for each vendor of non-registrable construction equipment reported

PCAB Form No. 201a

In behalf of ________________________________________________________________,
(Name of Firm)

holder of Contractor's License No. ___________, originally issued on __________________, I hereby request for Renewal of its Contractor's License for Contracting Fiscal Year 01 July 200___ to 30 June 200___.
I hereby certify to the completeness of the information/documents contained in this application appertaining to the category/classification the company is applying for and that they are true and correct. I am fully aware that: 1. all documents submitted in support of this application are subject to verification before PCAB action; 2. any discovered misrepresentation of information and/or manifestations of fraud on the application documents submitted by my firm applicant or its Authorized Representative/Agent/Liaison Officer shall be subjected to investigation which may result to the disapproval of my application, denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized Managing Officer; and 3. unconfirmed information/documents submitted to support my firm's qualifications will be excluded for categorization/classification purposes. 4. the evaluation of my application's qualification shall be solely based on the documents submitted at the time the application was filed/accepted by PCAB.

_______________________________ Authorized Managing Officer

(Signature over Printed Name)

Republic of the Philippines) ______________________)S.S. SUBSCRIBED AND SWORN TO before me this ________ day of ___________________ 20____ at ______________________; affiant exhibited to me his Community Tax Certificate No. _______________ issued at __________________ on _________________ 20 ___.

DOC. NO. _______________; PAGE NO. _________________________ BOOK NO._______________; SERIES OF_______________.

_______________; NOTARY PUBLIC (Until December 31, _______)

PCAB Form No. 202

GENERAL INFORMATION
A. CONTRACTORS IDENTIFICATION Name of Firm: Office Address: Tel./FaxNo:

If Provincial based, contact address in Manila, if any:

Tel./Fax No:

Website: Type of Organization (Please Check): [ ] Corporation [ ] Partnership SEC/BTRCP Registration No.: Employers I.D. No.: Original Contractor's License No.: _______________ License was last renewed during CFY 20 _____- 20 _____ PRESENT CATEGORY: PRESENT CLASSIFICATION/S: Principal: Others:

E-mail Address:

[ ] Sole Proprietorship

[ ] Joint Venture SEC/BTRCP Expiry Date:

Date of Registration:

Tax Identification No.: Date of Issue: _____________

B. OWNERS/STOCKHOLDERS/OFFICERS* (For Corporation, Partnership and Joint Venture) Name Position Nationality Capital Subscription Paid-Up Capital

C. AFFILIATION WITH OTHER LICENSED CONTRACTORS Name of Affiliated Firm Nature of Affiliation

CERTIFIED CORRECT BY: ____________________________________ Authorized Managing Officer (Signature over Printed Name)

Revised 03/31/04

PCAB Form No. 203

AUTHORIZATION
The Philippine Contractors Accreditation Board (PCAB) is hereby authorized to verify and secure information and/or copies of documents submitted by or in the name of the firm to any or all of the following agencies relative to its application filed with the PCAB: 1. 2. 3. 4. 5. Bureau of Internal Revenue Securities and Exchange Commission Land Registration Authority Land Transportation Office Social Security System

Name of Applicant Firm

_____________________________________

By: _____________________________________ Signature over Printed Name of Proprietor or Authorized Managing Officer

Date: _________________________________

03/31/04

PCAB Form No. 203a

THE MANAGER

_________________________________ _________________________________ _________________________________

Subject: Account # _______________________ Sir: Please provide the Philippine Contractors Accreditation Board (PCAB), a government agency under the Department of Trade and Industry, any information they need regarding the subject account with your bank. I am applying for a contractor's license from PCAB and part of their evaluation process is the verification of bank deposits and other assets of an applicant. This will serve as your authorization to release any information that may be requested by PCAB regarding the above subject account. Thank you. Very truly yours,

___________________________________ Signature over Printed Name ___________________________________ Company Name ___________________________________ Date

Note: To be submitted in two (2) copies.

Revised 03/31/04

PCAB Form No. 204

LIST OF NOMINATED SUSTAINING TECHNICAL EMPLOYEES OF THE COMPANY

PRC REGISTRATION Number Date Profession Date Employed Position in the Firm

NAME

May be reproduced if necessary

Revised 03/31/04

_________________________________________
Signature over Printed Name of AMO

_________________________________________
Company Name

_________________________________________
PCAB License No. (If applicable)

________________________________________
Date Signed

CFY __________________ Type of Application: (Pls. check) New Upgrading

Renewal

Others, pls. Specify __________________________ __________________________ __________________________

PCAB FORM 205

STATEMENT OF ANNUAL VALUE OF WORK ACCOMPLISHED As of the year ending _______

PROJECT PARTICULARS: 1 2 3

Title of project:

Project owner: Location: Classification/Total Cost : CONTRACT PARTICULARS Date of contract: Contract completion time : Scope of work: Amount of contract: Name of Main Contractor or Joint Venture Partner, if any:
WORK ACCOMPLISHMENT / / /

As of start of year: As of end of year :

______________ %_____ ______________ %_____

______________ %_____ ______________ %_____

_____________ %______ _____________ %______

TECHNICAL EMPLOYEE(S) Name and Profession: Position Title:

*** NOTES: See instructions at the back before filling up this form. This may be reproduce if necessary. ***
Revised 03/31/04

_______________________________________ Signature over Printed Name ________________________________________ Company Name ________________________________________ PCAB License No.

INSTRUCTIONS ON FILLING-UP PCAB FORM-205

PROJECT TITLE refers to the name of the particular project as stated in the contract. PROJECT OWNER refers to either government infrastructure agencies (e.g. DPWH, LWUA, MWSS, NIA, DOTC, etc.) LOCATION refers to the site of the particular project. CLASSIFICATION refers to the coverage or type of the work as stipulated in the contract. Choose a code of the following: (e.g. GE-1, GE-3, GB-1, SP-5, etc.) GENERAL ENGINEERING GE-1 Road, Highway Pavement, Railway Airport hor. Structure & Bridges Piling Work GE-2 Irrigation or Flood Control Soil Stabilization/Slope GE-3 Dam, Reservoir or Tunneling GE-4 SP-SS GE-5 Port, Harbor and Recreation Work GENERAL BUILDING GB-1 Building and Industrial Plants Mechanical Work GB-2 Sewerage and Sewage System GB-3 Water Treatment Plant& System GB-4 Park, Playground and Recreation Work SPECIALTY SP-FP Foundation or Piling Work FP2 Protection/Reinforced Earth Water Supply Structural Steel Works SP-CC Concrete Pre-Casting, Pre-stressing, or Post-Tensioning SP-PS Plumbing and Sanitary Work SP-EE Electrical Work SP-ME SP-AC Air-Conditioning or Refrigeration SP-ES Elevator and Escalator SP-FW Fire Protection Work SP-WP Water Proofing Work SP-PN Painting Work SP-WD Well Drilling Work SP-PP Power Generating Plants/ Power Transmission & Distribution SP-CF SP-MS SP-SD SP-LS SP-NF SP-EM Communication Facilities Metal Roofing & Siding Installation Structural Demolition Landscaping Navigational Facilities Electro Mechanical Work

FP1

Facilities

TOTAL COST refers to the overall project cost inclusive of owner furnished materials but exclusive of design and engineering fees and may be in the nature of a budgetary estimate. DATE OF CONTRACT refers to the date the contract was signed. CONTRACT COMPLETION TIME refers to the date the project will be finished or completed. SCOPE OF WORK refers to the extent of involvement in the contract whether: (a) Main Contractor, (b) Sub-Contractor or (c) Joint Venture. AMOUNT OF CONTRACT refers to the contract sum of the applicant firm inclusive of any change/variation/order/addition or deduction. NAME OF MAIN CONTRACTOR or JOINT VENTURE PARTNER indicate the name of the Main Contractor or Joint Venture Partner if the project undertaken is a sub-contract. WORK ACCOMPLISHMENTS - AS OF START AND END OF YEAR refers to the stage of completion of the contract work as of the first day and the last day, respectively, of the calendar/fiscal year, based on the contract billings (indicate the value and percent accomplishments). TECHNICAL EMPLOYEE(S) IN-CHARGE OF PROJECT refers to the Engineer or Architect assigned to supervise the actual construction implementation (indicate the name, profession and position title of the STE).

PCAB Form No. 206 Passport size Picture of STE

Republic of the Philippines ) Province of _____________ ) Municipality of ___________) S.S.

STE AFFIDAVIT
I,______________________________________________________________________, Filipino, of legal age,
LAST NAME FIRST NAME COMPLETE MIDDLE NAME

born on
M M / D D/ Y Y Y Y

single/married to _____________________________________________and

residing at ____________________________________________________________________ having duly sworn in accordance with law depose and say: 1. That I am a duly licensed __________________________ and holder of PRC registration no. ___________ valid up to _______________ (copy of my PRC is attached at the back hereof); 2. That I hold a Bachelor's Degree in _____________________________________________________ at ________________________________________________ given on ______________________; (NAME OF SCHOOL) 3. That my Tax Identification Number (TIN) and Social Security No. are and respectively;
4. That I am not presently employed in any government office or government owned/controlled corporation, nor a full time instructor, nor working abroad;
(NAME OF FIRM) (PROFESSION)

5. That I am employed by _________________________________________________________________ on regular and full-time basis with the position of _________________________________and presently being nominated as Sustaining Technical Employee for CFY _____________; 6. That I am not a holder of a contractor's license; 7. That I am not involved in any construction malperformance suggestive of negligence, incompetence or malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other person;
8. 9.

That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude; That I am fully aware that my failure to notify the PCAB of my disassociation with my present employer shall cause my disqualification to be sustaining technical employee or authorized managing officer or a license applicant with PCAB;

10. That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB may consider appropriate; 11. That I am executing this affidavit to attest to the truth of the foregoing. FURTHER AFFIANT SAYETH NAUGHT. _________________________________ Affiant SUBSCRIBED and sworn to before me this _____ day of ___________________, 200___ affiant exhibited his/her Community Tax Certificate No. _____________ issued at ___________________ on ______________. Doc. No. __________; Page No. __________; Book No. __________; Series of 200 _______.

Notary Public
Until December 200 ___

CFY ___________________ Type of Application: (Pls. check) New Upgrading Renewal Others, pls. specify __________________________ __________________________ __________________________
Revised 03/31/04

INSTRUCTIONS ON FILLING UP PCAB FORM NO. 206

QUALIFICATION REQUIREMENTS OF SUSTAINING TECHNICAL EMPLOYEE

1. 2. 3. 4. 5. a) A technology professional, such as engineer or architect, duly license by the Professional Regulation Commission. Holder of Professional I.D. valid for current year. Possesses at least (3) years of experience in implementation of construction to which he is to be nominated. A full-time employee of the nominating contractor, not associated professionally or by employment with any other party, particularly a party engaged in construction or construction-related activities. Have none of the following disqualifications: Involvement, in any capacity, in any construction malperformance of grave consequence, suggestive of his negligence, incompetence and/or malpractice; b) Involvement, by himself or in collaboration with any other person or firm, in any act or omission Liable for disciplinary action of which he or the other person or firm was found g guilty by the Board;

c) Conviction by a court of competent jurisdiction of any offense involving moral turpitude; and d) If formerly a Sustaining Technical Employee or an Authorized Managing Officer of any Construction firm but disassociated therefrom, failure to notify the Board of his disassociation in accordance with paragraph 5 and 6 of the Affidavit of Undertaking. 6. Not a holder of a contractor's license. If you meet the above requirements, kindly accomplish this affidavit. Erasure must be properly initialled. All statements are subject to verification and any false statement or willful misrepresentation of a material fact in obtaining a license shall be grounds for disapproval of this application.

PASTE PROF. I.D. CARD VALID FOR CURRENT YEAR (Front) (xerox copy)

PASTE PROF. I.D. CARD VALID FOR CURRENT YEAR (Back) (xerox copy)

This is to certify that I have verified with PRC the abovestated professional eligibility/registration of the Sustaining Technical Employee. Affiant herein and found the same to be true and correct.

__________________________________________ AUTHORIZED MANAGING OFFICER Date: __________________

PCAB Form No. 207 Republic of the Philippines ) Province of _____________ ) Municipality of ___________) S.S.

AFFIDAVIT OF STE CONSTRUCTION EXPERIENCE

I, _____________________________ ____, single/married, Filipino, of legal age, with postal address at _________________________________________ _______, having been duly sworn in accordance with law depose and say that the projects enumerated below constitute my full & complete construction experience.
NAME and COMPLETE ADDRESS of EMPLOYER/ NAME & LOCATION of PROJECTS UNDERTAKEN Work Classification (GE, GB, SP) Nature/Scope of Work Assignment (Proj. Engr.) PROJECT DURATION (mm/dd/yy)

From

To

That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB may consider appropriate; That I am executing this affidavit to attest to the truth of the foregoing. FURTHER AFFIANT SAYETH NAUGHT. Affiant SUBSCRIBED and sworn to before me this _____ day of _________________, 200__ affiant exhibited his/her Community Tax Certificate No. ______________ issued at ____________________ on ____________________. Doc. No. __________; Page No. __________; Book No. __________; Series of 200 _______. CFY ___________________ Type of Application: (Pls. check) New Upgrading Renewal

_________________________________

Notary Public Until December 200 ___ Company Name ____________________________ PCAB License No. _________________________ Others, pls. specify ___________________________ ___________________________
Revised 03/31/04

PCAB Form No. 208

SUSTAINING TECHNICAL EMPLOYEE (STE) PERSONAL APPEARANCE FORM (To be accomplished fully by the STE)

Name: ______________________________________________ Sex: _____________ Address: _______________________________________________________________ Profession: __________________________________ PRC Reg. No.:_____________ Nominating Firm: _______________________________________________________ Contractor's License No.: ______________________
I hereby confirm the following: 1. The veracity of the information reflected on the STE Affidavit and Affidavit of Construction Experience (PCAB Form Nos. 107 & 108, copies attached) that I executed in favor of the above firm; 2. That I am fully aware that my failure to notify the PCAB of my disassociation from the above-stated nominating firm and any misrepresentation in the attached forms shall cause my disqualification as sustaining technical employee, or authorized managing officer, or a licensee applicant with PCAB per Board Resolution No. 401, Series of 2001.
3. That I have been previously connected with the following companies: Previous Employers
Date of Employment Date of Resignation

Position

4.

Other Remarks:

_____________________________________________________________________________________________________

____________________________________________________________________________________

______________________________ STE's Signature Date Signed: ______________________

Identification Documents Presented:
PRC ID No. _____________________ 2. Personal Appearance and Presentation of Two (2) Identification Documents attested by PCAB designated staff or DTI Regional/Provincial Staff valid until _______________________

____________________________

_______________________________
Signature over Printed Name/Position DTI Office Address: _____________________________________________________ Date: ____________________________

PCAB Form No. 204a

LIST OF LAND, BUILDING AND OTHER IMPROVEMENTS OWNED BY AND REGISTERED IN THE NAME OF THE COMPANY AS OF THE BALANCE SHEET DATE

COMPLETE DESCRIPTION (Type of land/building and area)

TCT/CCT NUMBER

LOCATION
(St. #, Barangay, Municipality/ City, Province)

ACQUISITION COST

ACQUISITION DATE

May be reproduced if necessary

Revised 03/31/04

_________________________________________

Signature over Printed Name of AMO

_________________________________________ Company Name _________________________________________ PCAB License No. (If applicable) ________________________________________ Date Signed

CFY ___________________

PCAB Form No. 204b

LIST OF DELIVERY AND TRANSPORTATION EQUIPMENT OWNED BY AND REGISTERED IN THE NAME OF THE COMPANY ASOF THE BALANCE SHEET DATE COMPLETE DESCRIPTION
Plate No. Chassis No. Engine No. M.V. File No. CR No. ACQUISITION Date Cost

VALUE

BOOK

TOTAL

LIST OF MACHINERIES/PLANTS AND OTHER CONSTRUCTION EQUIPMENT OWNED BY THE COMPANY AS OF THE BALANCE SHEET DATE COMPLETE DESCRIPTION

SERIAL NO.

ACQUISITION Date Cost P

VALUE

BOOK

TOTAL
May be reproduced if necessary

P
Revised 03/31/04

_________________________________________ Signature over Printed Name of AMO _________________________________________ Company Name _________________________________________ PCAB License No. (If applicable) ________________________________________ Date Signed

CFY _________________

PCAB Form No. 209

SCHEDULE OF RECEIVABLES
To be accomplished if the applicant's receivable accounts (accounts/contracts & other receivable) exceed 20% of the total networth/equity as of the latest audited balance sheet submitted in support of its application.

TYPES

AMOUNT

AGE

NAME/ADDRESS OF DEBTOR/CLIENTS

Notes: * All receivable accounts must be substantiated by confirmation of debtors/clients Please use necessary sheets if necessary

Certified by: __________________ Authorized Managing Officer

_________________ Certified Public Accountant

SCHEDULE OF INVENTORIES
To be accomplished if the applicant's inventory accounts exceed 20% of the total networth/equity as of the latest audited balance sheet submitted in support of its application.

Types

AMOUNT

Age/Date Acquired

Intended Use or

Purpose for Storing

Physical Condition

Place of Storage

Please use necessary sheets if necessary

03/31/04

Certified by: __________________ Authorized Managing Officer

_________________ Certified Public Accountant

PCAB Form 111-A (For sole proprietorship)

Republic of the Philippines) s.s. _______________________)

AFFIDAVIT
I, _______________________________, of legal age, Filipino, married/single with postal address at ____________________________________, after having been sworn to in accordance with law, hereby depose and say:
1. That I am the Proprietor/Authorized Managing __________________________________________________________; (Name of Firm) Officer (AMO) of

2. That I appoint ____________________________, whose picture and signature appear below, to transact business with PCAB; i.e, present for pre-screening my application for contractors license or any application related thereto, file/follow-up, submit documents, receive notices/license in connection with the said application and the like.

Passport size Picture of Representative

______________________________ (Signature over Printed Name of representative ) ______________________________ ______________________________

COMPLETE HOME /MAILING ADDRESS

3. That I am aware that I am responsible/liable for any or all acts/representation made by my representative in connection with the functions stated herein. 4. That I undertake to notify PCAB in the event that this appointment is modified, amended or revoked.

_____________________________ AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ____________, 20___, affiant exhibited his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________.
Doc No. __________ Page No. _________ Book No. _________ Series of _________ Notary Public Until December 200 ___

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)

PCAB Form 111-B (For corporation.,partnership,cooperative joint venture or consortium)

Republic of the Philippines) s.s. _______________________)

AFFIDAVIT
I, _______________________________, of legal age, Filipino, married/single with postal address at ____________________________________, after having been sworn to in accordance with law, hereby depose and say:
1. That I am the Authorized Managing ________________________________________; (Name of firm) Officer (AMO) of __________

2. That the abovestated firm had duly appointed ____________________________, whose picture and signature appear below, to transact business with PCAB; i.e, present for pre-screening its application for contractors license or any application related thereto, file/follow-up, submit documents, receive notices/license in connection with the said application and the like. ______________________________ (Signature over Printed Name of representative ) ______________________________ ______________________________
COMPLETE HOME /MAILING ADDRESS

Passport size Picture of Representative

3. That we are aware that we are responsible/liable for any or all acts/representation made by the above representative in connection with the functions stated herein. 4. That the firm undertakes to notify PCAB in the event that this appointment is modified, amended or revoked.

____________________________________
AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ______________, 20__ affiant exhibited his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________.
Doc No. __________ Page No. _________ Book No. _________ Series of _________ Notary Public Until December 200 ___

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)

ARC Form 601

Application for REGISTRATION AND CLASSIFICATION OF CONTRACTOR FOR GOVERNMENT INFRASTRUCTURE PROJECTS with the Philippine Contractors Accreditation Board

(Name of Firm) a contractor duly licensed with the Philippine Contractors Accreditation Board. I hereby request for registration pursuant to the implementing Rules and Regulations of PD 1594, as amended.

In behalf of ____________________________________________________________

I hereby certify that the information and documents contained in this application are true and correct of my own personal knowledge. I am fully aware that I shall be held personally liable for any misrepresentation that may be found herein. ____________________________________
Authorized Managing Officer Republic of the Philippines} _______________________} s.s. SUBSCRIBED AND SWORN to before me this _______ day of ___________________ 200 ___ at ___________________________________ affiant exhibited to me his Community Tax Certificate No. ______________ issued at _________________________ on ________________ 200 ____. Doc. No. :
(Signature over Printed Name)

Page No. :
Book No. : Series of :

NOTARY PUBLIC Until December 31, 200 ___

The following documents and information are hereby submitted in support of this registration application:
]

Checklist of Registration Application:

1. General Information (PCAB Form No. 602). 2. List of Single Largest Contract completed by the contractor of each Project Kind being applied for (PCAB Form No. 603). 3. Copy of Contract Agreement listed in PCAB Form No. 603 of each Project Kind being applied for duly authenticated by the tendering agency or project owner or in case of subcontract by the prime/main contractor. 4. Copy of Certificate of Acceptance/Completion from Tendering Agency/Project Owner of each Contract Agreement submitted duly authenticated by the tendering agency or project owner or in case of subcontract by the prime/main contractor. 5.Copy of Certificate of Creditable Income Tax Withheld (Form 1743.1/1743.750/2307), stamped-received by BIR for each private contracts and sub-contracts.

NOTE: Application for registration and supporting documents must be submitted in a folder and signed on each and every page by the Proprietor/Authorized Managing Officer. Do not fill, for PCAB use only: Total no. of pages submitted ________ Checklisted by: ___________________________________
(Signature over Printed Name)

Remarks: __________________________________________________ __________________________________________________

_________________ (Date)
(Revised 032601_GSD)

Note: Only citizens or entities with at least 75% Filipino equity may apply

Registration- Page 18 of 22

PCAB Form No. 602

GENERAL INFORMATION SHEET Contractors Particulars

FIRM NAME

:
TEL, NO.:

OFFICE ADDRESS:

TYPE OF ORGANIZATION: EQUITY:

Corporation %

Partnership %

Sole Proprietorship

Filipino:

Foreign:

License Particulars
Contractors License No.: Principal Classifications: Other Classification(s): Date Issued: Last Renewal:

CFY _____ - _____

Present Category:

_____________________________________________________________________ _____________________________________________________________________ Ref. No.:

Type of application for PCAB License amendment, if any: Government Registration Particulars

PRESENT REGISTRATION VALIDITY PERIOD, if applicable: from _______________ to ________________

APPLICATION APPLIED FOR:

New Registration Re-registration
Please indicate if: Small A, Small B, Medium A, Medium B, Large A, Large B

Upgrading

Additional Project Kind

SIZE RANGE

KIND OF PROJECT
(Please check)

__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

GENERAL ENGINEERING GE-1 Road, Highway pavement, Railways, Airport horizontal structures, & Bridges GE-2 Irrigation and Flood Control GE-3 Dam, Reservoir, and Tunneling GE-4 Water Supply GE-5 Port, Harbor, and Offshore Engineering GENERAL BUILDING GB-1 Building and Industrial Plant GB-2 Sewerage and Sewage Treatment/Disposal Plant GB-3 Water Treatment Plant and System GB-4 Park, Playground, and Recreational Work SPECIALTY SP-1 Foundation Work SP-2 Structural Steel Work SP-3 Concrete Pre-casting and Pre-stressing SP-4 Plumbing and Sanitary Work SP-5 Electrical Work SP-6 Mechanical Work SP-7 Air-conditioning and Refrigeration Work SP-8 Elevator and Escalator Work SP-9 Fire Protection Work SP-10 Waterproofing Work SP-11 Painting Work SP-12 Well Drilling Work SP-13 Navigational Facilities SP-14 Communications Facilities

CERTIFIED CORRECT BY: _______________________________ Authorized Managing Officer/ Proprietor

(Signature over Printed Name)

Registration- Page 19 of 22

PCAB Form No. 603 TRACK RECORD FORM (Only complete form & supporting documents will be considered)
_________________________________________________________________________ __________________

Name of Firm

License No.

SINGLE LARGEST CONTRACTS COMPLETED

For ________________________________________ Project Kind applied for (e.g. Road, Building etc.) I. CONTRACT Project Title: ________________________________________________________ ________________________________________________________ ________________________________________________________ Project Location: ________________________________________________________ Project Owner: ________________________________________________________ Date of Contract: ___________________ Amount of Contract: P _________________ Name of Main Contractor or Joint Venture, if any: _________________________________ Percent (%) share of the applicant in the contract: ____________ % II. ACCEPTANCE Date of Document: Name of Signatory: ________________________ Date Accepted: __________________

_________________________ Position: _______________________

III. WITHHOLDING TAX (for subcontract and non-government contract) Withholding agent: ________________________________________________________ Name of the withholding agent's signatory: _____________________________________ Received and Stamped by: { BIR { BANK RDO No._______________________ Address: _______________________ _______________________________ Date: __________________________ Name: ________________________ Address: ______________________ _____________________________ Date: _________________________

INSTRUCTIONS: 1. Attach at the back of this form clear & legible copies of the following documents: a) Contract agreement duly authenticated by the tendering agency/project owner/ prime contractor in case of subcontract. b) Letter or certificate of acceptance duly authenticated by the tendering agency/ project owner/prime contractor in case of subcontract. c) Certificate of creditable income tax withheld of source (BIR Form 1743.1, 1743.750 or 2307) duly stamped-received by the BIR or Bank Collecting Agent for subcontracts & non-government or private contracts) 2. Submit only one track record for each project kind. _______________________________________________ Authorized Managing Officer/Proprietor (Signature over Printed Name)

Registration- Page 20 of 22

PCAB Form 111-A (For sole proprietorship)

Republic of the Philippines) s.s.

_____________________)

AFFIDAVIT
I, _______________________________, of legal age, Filipino, married/single with postal address at ____________________________________, after having been sworn to in accordance with law, hereby depose and say:
5. That I am the Proprietor/Authorized Managing Officer __________________________________________________________; (Name of Firm) (AMO) of

6. That I appoint ____________________________, whose picture and signature appear below, to transact business with PCAB; i.e, present for pre-screening my application for contractors license or any application related thereto, file/follow-up, submit documents, receive notices/license in connection with the said application and the like. ______________________________ (Signature over Printed Name) _______________________________ _______________________________
HOME /MAILING ADDRESS

Passport size Picture of Representative _______

7. That I am aware that I am responsible/liable for any or all acts/representation made by my representative in connection with the functions stated herein. 8. That I undertake to notify PCAB in the event that this appointment is revoked. modified, amended or

________________________

AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ____________, 20___, affiant exhibited his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________.
Doc No. __________ Page No. _________ Book No. _________ Series of _________ Notary Public Until December 200 ___

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)

Registration- Page 21 of 22

PCAB Form 111-B (For corporation.,partnership,cooperative joint ventue or consortium)

Republic of the Philippines) s.s.

_____________________)

AFFIDAVIT
I, _______________________________, of legal age, Filipino, married/single with postal address at ____________________________________, after having been sworn to in accordance with law, hereby depose and say:
1. That I am the Authorized Managing ________________________________________; (Name of firm) Officer (AMO) of __________

2. That the abovestated firm had duly appointed ____________________________, whose picture and signature appear below, to transact business with PCAB; i.e, present for pre-screening its application for contractors license or any application related thereto, file/follow-up, submit documents, receive notices/license in connection with the said application and the like. ______________________________ (Signature over Printed Name) Passport size Picture of Representative ______________________________ ______________________________
HOME /MAILING ADDRESS

3. That we are aware that we are responsible/liable for any or all acts/representation made by the above representative in connection with the functions stated herein. 4. That the firm undertakes to notify PCAB in the event that this appointment is modified, amended or revoked.

________________________

AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ______________, 20__ affiant exhibited his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________.
Doc No. __________ Page No. _________ Book No. _________ Series of _________ Notary Public Until December 200 ___

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)

Registration- Page 22 of 22