BLR Form No.

4, Series of 2024
This form is NOT FOR SALE

Republic of the Philippines

DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. 12

APPLICATION FOR REGISTRATION

(WORKERS’ ASSOCIATION (WAs))
DATA PRIVACY NOTICE: Collection of information such as name, address, contact number and other personal data is necessary to
facilitate your application. By filing a duly accomplished form, you are agreeing to the processing of the collected information consistent
with existing laws, rules and regulations.
PART I. INFORMATION ABOUT THE REPORTING ORGANIZATION Date Accomplished (mm/dd/yyyy)
To be accomplished by the applicant. Supply all required information. Misrepresentation, false statement or fraud in this
application or any supporting document is a ground for denial or cancellation of registration.

Contact Information
Name of Applicant Association E-mail: ________________________________
Landline No: ___________________________

Address Mobile No: _____________________________

Name of President Contact Information

(First Name) (M.I.) (Last Name)
E-mail: ________________________________ E-mail: _
Landline No: ___________________________ Landline
Address Mobile No: _____________________________ Mobile N

Gender Male Female Others

Padding

Date of CBL Ratification (mm/dd/yyyy)

Date Organized (mm/dd/yyyy)

Occupation of Members. Please check appropriate category. No. of Association Members

Agricultural Workers Male
( Farmers  Fisher folk  Artisans  Cottage  Others _________________ ) Female
 Transport Workers
TOTAL
(Drivers:  Jeepney  FX  Tricycle  Pedicab  Bus  Others _________)
 Home-based / Homeworkers
Please specify economic activity __________
 Construction Workers
 Vendors
( Market  Sidewalk  Ambulant  Others _________________)
 Miners
 Others, Please specify
____________________________________________________________

I attest to the truth of the foregoing.

________________________________________________
President
(Signature over printed name)

Subscribed and sworn to before me at ___________________________________________________, Philippines,

this _______ day of _________________ 20 _______ with I.D. No. _________________________________________
issued by ___________________________________________________ on _________________________________.

NOTARY PUBLIC

Doc. No. __________

Page No. __________
Book No. __________
Series of __________
BLR Form No. 4, Series of 2024
This form is NOT FOR SALE
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PART II. PROCESSING OF REQUIREMENTS Date Received(mm/dd/yyyy)

(WORKERS’ ASSOCIATION)

A. CHECKLIST. ALL DOCUMENTS MUST BE CERTIFIED CORRECT BY THE SECRETARY OR

TREASURER, AS THE CASE MAYBE, AND ATTESTED TO BY THE PRESIDENT OF THE WORKERS’
ASSOCIATION.

Duly accomplished application form shall be accompanied by the original copy and two (2) duplicate original copies
of the following documents (Section 2-C, Rule III of D.O. 40-03, as amended):

 1. Duly filled-up notarized Application Form

 2. Names of the applicant association’s officers and their respective addresses
 3. Minutes of the organizational meeting/s
 4. List of members who participated in the organizational meeting/s
 5. Annual financial reports if applicant has been in existence for one or more years
 Certification that the applicant association has not collected any amount from the members
 6. Constitution and By-laws
 7. Minutes of adoption or ratification of the CBL and date/s when ratification was made
 CBL was ratified or adopted during the organizational meeting/s and such fact is reflected in the minutes of
organizational meeting/s
 8. Names of members who participated in the ratification of CBL
 List of ratifying members is included in the list of members who participated in the organizational meeting/s
 9. Registration Fee

B. RECOMMENDATION ON THE APPLICATION:

 Recommending Approval with Registration Certificate No.

 Recommending Denial due to failure to comply with documentary requirements (Refer to Denial letter for the
lacking documents)

By: ___________________________
Processor
(Signature over printed name)

Date: __________________________

PART III. ACTION ON THE APPLICATION

A. APPROVAL / DENIAL

Respectfully endorsed to the Director

 Recommending Approval of the Certificate of Registration

 Recommending Denial due to failure to comply with documentary requirements

___________________________ ___________________________
Division Chief Date
(Signature over printed name)