Permit S

This certifies that
SAUCETAIN
BARANGAY CINCO, P TORRES ST. LIPA CITY, BATANGAS, REGION 4-A (CALABARZON)
is a business name registered in this office pursuant to the provisions of Act 3883, as amended by
Act 4147 and Republic Act No. 863, and in compliance with the applicable rules and regulations
prescribed by the Department of Trade and Industry. This certificate issued to
DAZELCA VIENZELL
PAYAPA, PADRE GARCIA BATANGAS, REGION 4-A (CALABARZON)
is valid from XX Month XXXX to XX Month XXXX subject to continuing compliance with
the above-mentioned laws and all applicable laws of the Philippines,
unless voluntarily cancelled.
In testimony whereof, I hereby sign this
Certificate of Business Name Registration

and issue the same on this 10th day of October 2016 in the Philippines.
Certificate No. XXXXXXX

This certificate is not a license to engage in any kind of business and valid only at the scope
indicated herein.
TRN XXXXXXXX
Republic of the Philippines
LIPA CITY HEALTH
DEPARTMENT
Lipa City, Batangas
P. Torres street, Lipa City
Contact no: XXXXXXXXXXX
Issued to: Dazelca Vienzell (Saucetain)
Address: P. Torres street, Public Market, Lipa city
Type of Establishment: Condiment Refilling Station
Effective Date:
This permit is hereby issued to Dazelca Vienzell (Saucetain) upon the following conditions:
General Requirements:
 The condiment station shall maintain a clean and sanitary environment at all times.
 All refilling equipment shall be clean, sanitized, and in good working order.
 All condiment containers shall be stored in a clean and dry location.
 Adequate pest control measures shall be in place to prevent the entry and harborage of pests.
Employee Requirements:
 All employees shall wash their hands thoroughly with soap and water before and
after handling condiments.
 All employees shall wear clean and non-shedding clothing while working at the
condiment station.
 All employees shall avoid wearing jewelry or other accessories that could come into
contact with condiments.
 All employees shall receive training on sanitary condiment handling practices.
Additional Requirements for Condiment Refilling Stations:
 The condiment station shall have a designated area for washing and sanitizing
condiment containers.
 The condiment station shall have a written food safety plan.
 The condiment station shall keep records of all condiment sanitation and inventory records.
 The condiment station shall be subject to regular inspections by the Department
of Environmental Health.
 Permit Holder Acknowledgement:
I, Almedilla, Haizell, acknowledge that I have read and understand the conditions of this sanitary
permit. I agree to comply with all of the conditions listed above. I understand that failure to comply
with these conditions may result in the suspension or revocation of my permit.
Signature Over Printed Name
ALMEDILLA HAIZELL
General Manager
Date:
By complying with these requirements, condiment refilling stations can help to ensure that the
condiments they provide are safe and clean for consumption
LIPA CITY HEALTH
DEPARTMENT
Lipa City, Batangas
Effective Date:
condiment station.
I, Roxas, Danica L, acknowledge that I have read and understand the conditions of this sanitary
ROXAS, DANICA L.
Operational Manager
Date:
LIPA CITY HEALTH
DEPARTMENT
Lipa City, Batangas
Effective Date:
condiment station.
I, Puso, Rica Gin G. acknowledge that I have read and understand the conditions of this sanitary
PUSO, RICA GIN G.

Safety and Maintenance Manager
Date:
LIPA CITY HEALTH
DEPARTMENT
Lipa City, Batangas
Effective Date:
condiment station.
I, Santos, Vivien Mariz E. acknowledge that I have read and understand the conditions of this
sanitary permit. I agree to comply with all of the conditions listed above. I understand that failure to
comply with these conditions may result in the suspension or revocation of my permit.
SANTOS VIVIEN MARIZ E.

Marketing Manager
Date:
or consumption
LIPA CITY HEALTH
DEPARTMENT
Lipa City, Batangas
Effective Date:
condiment station.
I, Ilagan, Jhiezel V. acknowledge that I have read and understand the conditions of this sanitary
ILAGAN, JHIEZEL V.
Financial Manager
Date:
condiments they provide are safe and clean for consumption.
City of Lipa
Office of the Mayor
Barangay Clearance
(Establishment of Business or Trade Activity)
(Date)
TO WHOM IT MAY CONCERN:
This is to certify that Dazelca Vienzel of Barangay Cinco P.

Torres street, Lipa City, Batangas has filed with this OFFICE as application for clearance
regarding the establishment of Dazelca Vienzell in this Barangay on
Cinco P. Torres street, Lipa City, Batangas said application have
found not violating any existing barangay ordinances, rules and regulations, the same is hereby
granted and the clearance sought for is hereby authorized.
Furthermore, this office interpose no objection to the issuance of the corresponding

Mayor’s Permit for the establishment of the said business or activity.
This Barangay clearance is issued in compliance with Section 152 @ R.A. 7160
otherwise known as Local Government Code of 1991.
Barangay Captain
City of Lipa
Province of Batangas
OFFICE OF THE MAYOR

BUSINESS PERMIT AND LICENSING OFFICE
PERMIT NO: XXXX:XX
Pursuant to the provisions of the 2001 Revised Revenue Code of Cainta, Rizal, and
Local Government Code of 1991, PERMIT is hereby GRANTED to:
DAZELCA VIENZELL
BUSINESS NAME
REFILLING STATION
Nature of Business
DAZELCA VIENZELL
Owner's Name
Barangay Cinco P. Torres street, Lipa City, Batangas
CONDITIONS FOR THE VALIDITY OF THIS PERMIT

• This permit must be displayed at all times in a conspicuous place in the business
establishment.
• This permit is Non-Transferable.
• This permit shall be subject to all existing pertinent laws and ordinances, rules and regulations
governing the business or trade activity.
• This permit is not valid if not counter signed by the BPLO Chief or there is an alteration in it or
if taxes, fees, charges are not paid pursuant to the existing Municipal Tax Ordinance.
• In case of retirement from business, trade or occupation, the permit owner/holder shall notify
the Office of the Municipal Treasurer not later than the date of retirement and shall surrender
this permit and business plate issued.
• Any violation of the terms and conditions for which this permit was granted or when public
interestwill so require shall be enough ground to REVOKE the said permit and CLOSURE of the
business establishment.
APPROVED BY:
Medical Certificate
Date: Month XX XXXX
Patient Name: Dazelca Vienzell

Address: Barangay Cinco, P Torres street, Lipa City, Batangas
Patient Phone Number: XXXXXXXXXXX
Patient Date of Birth:
Physician Name:
Physician Address:
Physician Phone Number:
Physician License Number:
Purpose of Certificate
This is to certify that the above-named patient has been examined by me and is
found to be:
Patient’s medical condition:
Recommendations:
Any additional information relevant to the patient’s medical condition or the
purpose of the certificate
Physician Signature
Printed Physician Name

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This certifies that

In testimony whereof, I hereby sign this

Certificate of Business Name Registration

Certificate No. XXXXXXX

Issued to: Dazelca Vienzell (Saucetain)

Address: P. Torres street, Public Market, Lipa city

Type of Establishment: Condiment Refilling Station

Signature Over Printed Name

Issued to: Dazelca Vienzell (Saucetain)

Address: P. Torres street, Public Market, Lipa city

Type of Establishment: Condiment Refilling Station

Signature Over Printed Name

Issued to: Dazelca Vienzell (Saucetain)

Address: P. Torres street, Public Market, Lipa city

Type of Establishment: Condiment Refilling Station

Signature Over Printed Name

PUSO, RICA GIN G.

Issued to: Dazelca Vienzell (Saucetain)

Address: P. Torres street, Public Market, Lipa city

Type of Establishment: Condiment Refilling Station

Signature Over Printed Name

SANTOS VIVIEN MARIZ E.

Issued to: Dazelca Vienzell (Saucetain)

Address: P. Torres street, Public Market, Lipa city

Type of Establishment: Condiment Refilling Station

Signature Over Printed Name

Office of the Mayor

TO WHOM IT MAY CONCERN:

This is to certify that Dazelca Vienzel of Barangay Cinco P.

Furthermore, this office interpose no objection to the issuance of the corresponding

OFFICE OF THE MAYOR

CONDITIONS FOR THE VALIDITY OF THIS PERMIT

Date: Month XX XXXX

Patient Name: Dazelca Vienzell

Patient’s medical condition:

Printed Physician Name

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