Form No.

010-TD
Revised as of 2/24/2021

Republic of the Philippines

Department of Transportation
LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD
East Avenue, Diliman, Quezon City

PETITION TO ADOPT TRADE NAME

Denomination_______________
No. of Unit/s ________________
Route/Area of Operation____________________________

NAME OF APPLICANT: _______________________________ CASE NO. __________

Authorized Representative:

HOME/BUSINESS ADDRESS: _________________________________________________

TELEPHONE NUMBER: _______________ EMAIL ADDRESS: ________________

CITIZENSHIP: ______________________

AUTHORIZED UNIT DETAILS:

MAKE MOTOR NO. CHASSIS NO. PLATE NO. YR. MODEL
_______ ________________ __ _________________ __________ _________

ATTACHMENTS:

Valid Government ID of Applicant (Annex ____)

or Authorized Representative

For Corporation/Partnership/Cooperative
Board Resolution/Sec. Certificate of
Authorized Signatory to sign and/or file
the Petition (Annex ____)

Additional attachment:
DTI Certificate (Annex ____)

I hereby CERTIFY under oath that the information provided in the Petition is true and
correct. I/We, further CERTIFY that any false representation hereby made shall automatically
cause the denial of the Petition, without prejudice to other penalties as may be determined by the
Board.

_____________________
Petitioner