ANNEX B

REVISED PNP FORM 6-Al

As of April 2016
Republic of the Philippines
NATIONAL POLICE COMMISSION
I
I PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City PASSPORT SIZE OF THE
APPLlCANT/APPLlCANT-
REPRESENTATIVE

APPLICA TION FOR LICENSE

CHIEF, PHILIPPINES NATIONAL POLICE
Camp Crame, Quezon City

Type of Application
DNew D Renewal D Amendment l Dat& of Application
December 4, 2023
Company Name
Gruppo EMS, Inc.
Nature I Line of
Business C Manufacturer D Dealer D Purchaser IS~or I D Government D Private D School

Office Address ZIP Code

117 Technology Avenue, Laguna Technopark Inc. SEZ, Biñan, Laguna 4024
Facility Address ZlP Cod&
102 West Main Avenue, Laguna Technopark Annex, Biñan, Laguna 4024
Warehouse Address
102 West Main Avenue, Laguna Technopark Annex, Biñan, Laguna
COMPANY HEAD ANDIOR AUTHORIZED REPRESENTATIVEIS INFORMA TlON
Name of Company Jose Noel C. Ramirez 1 Designation
General Manager
Head
Home Address ZIP Code
B3 L9 Cattleya St. Camella Classic Sub. Better Living Parañaque City 1711
Contact#S
(049)541 0213 I
Email Address
I

Name of Authorfnd 'I DesIgnation

RejJresentative Ma. Irene Villanueva Pollution Control and Safety Officer
Home Address ZlPCod&
Blk 2 Lot 3 Mt. Claire San Rafael, Sto. Tomas, Batangas 4234
I
Contact#S 0927-279-2811 1 Email Address irenev@ems.com.ph

CONTROLLED CHEMICALIS TO BE LICENSED:

QTY RECOMMENDED
KIND QUANTITY APPLIED REMARKS
BYFEO
1. Mixed Acid Etchant 6.1.1 2,000 L Indicate storage capacity
2. Hydroflouric Acid 49% 360 L versus production capacity
3. Hydroflouric Acid 5% 1,500 L for one (1) year
4. Hydrogen Peroxide solution 33.5% 80 L
5. Hydrogen Peroxide 12% 1,000 L

In support of this application, the undersigned applicanVapplicant-representative enclosed hereto the original/authenticated copies of the following
documentary requirements :
D For applicant: shall be represented by the owner, in case of sole proprietorships or partnerships, or, in case of corporations, by the president or
any corporate officer or member of the Board empowered through a Secretary's Certificate_
D For authorized representative: Special Power of Attorney (SPA) stating that he/she has been authorized by the applicant for the purpose of
processing the application for license.
D For local corporation/partnership: Certificate of Registration of the firm with the Securities and Exchange Commission (SEC) to include its
machine validated Articles of Incorporation and General Information Sheet (GIS) . (For New and Amendment)
D For foreign multi-corporation: SEC Registration to do business to do business in the Philippines .

D For Single Proprietorship: Certificate of Registration with the Department of Trade and Industry (DTI) . (For New and Amendment)

D Personal Data Sheet (PDS) of the applicant and the management personnel of the storage facility/warehouse. (For New and Amendment)

D NBI Clearance of the applicant (For New and Amendment)

D Business Permit

D Process flowchart. (For New and Amendment)

D Material Safety Data Sheet (MSDS)/Safety Data Sheet (SDS) of controlled chemicals . (For New and Amendment)

D Vicinity Map of the factory and storage facility showing distance from the nearest Police Headquarters

D Floor/Location Plan of the storage facility (For New and Amendment)

D For Metro Manila Applicant: Security Survey Inspection from Chief of Police and Certificate of Inspection from C, EEMD, FEO .

D For outside Metro Manila Applicant: Security Survey Inspection from ProvinCial Director/City Director

D Proof of Payment from the Land Bank of the Philippines

o Certificate of Good Standing (as applicable)

I solemnly swear that the information above are true and correct. Further, in compliance with the requirements pertaining to controlled chemicals which are
now or hereafter maybe enforced and in adherence to existing laws, rules and regulations, I would like to request your good office to conduct security
survey and storage facility inspection in connection with our application as indicated above.

Ma. Irene P. Villanueva

Printed Name and Signature of Applicant
 ANNEX B

undersigned respectfully RECOMMENDS THE APPROVAL of the application and certifies the completeness and
validity of applicant's documentary requirements.
Attached is the Security Survey Inspection Report
undersigned regretfully DENY THE APPLICATION due to the following:
o Incomplete documentary requirements, i.e _ _ _ _._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _., and

is not safe pursuant to the Security Survey Inspection Report.

undersigned respectfully RECOMMENDS THE APPROVAL of the application and certifies the completeness of
applicant's documentary requirements. The undersigned further recommends the following:
DOuanlity of the controlled chemicals pursuant to the Storage Inspection Report; and

Attached are the following documents:

o Properly labeled pictures (8"x10" in size) of storage facility with PNP Inspecting Team printed in photo paper; and
Storage Facility Inspection Report.
undersigned regretfully DENY THE APPLICATION due to the following:
o Incomplete documentary requirements, i.e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _,
is not safe pursuant to the Security Survey Inspection Report; and
'"fflr"el''' Facility does not conform to the parameters pursuant to the Storage Facility Inspection Report.

CHIEF, REGIONAL CIVIL SECURITY UNIT

undersigned respectfully RECOMMENDS THE APPROVAL of the application and certifies the completeness of
applicant's documentary requirements
Attached are the following documents:
labeled pictures (8"x10" in size) of storage facility with PNP Inspecting Team printed in photo paper.
Facility Inspection Report.
undersigned regretfully DENY THE APPLICATION due 10 the following:
Incomplete documentary requirements, i.e. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

is not safe pursuant to the Security Survey Inspection Report; and

Facility does not conform to the parameters pursuant to the Storage Facility Inspection Report.

RECOMMEND:

RECOMMEND;
DAPPROVAL
DISAPPROVAL

APPROVED: This license shall be valid for a from the date of issuance to the conditions
and under RA No. "Iomonli,,,.,Rules and other laws, rules and

DISAPPROVED