REVISED PNP FORM 6-A1

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

APPLICATION FOR LICENSE

CHIEF, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

Type of Application Date of Application

 New  Renewal  Amendment
Company Name

Nature / Line of Sector

Business  Purchaser  Government  Private  School

Office Address ZIP Code

Facility Address ZIP Code

Warehouse Address

COMPANY HEAD AND/OR AUTHORIZED REPRESENTATIVE/S INFORMATION

Name of Company Designation
Head
Home Address ZIP Code

Contact #s Email Address

Name of Authorized Designation

Representative
Home Address ZIP Code

Contact #s Email Address

CONTROLLED CHEMICAL/S TO BE LICENSED:

QTY RECOMMENDED
KIND QUANTITY APPLIED REMARKS
BY FEO

In support of this application, the undersigned applicant/applicant-representative enclosed hereto the original/authenticated copies of the following
documentary requirements:
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.
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.
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)
For foreign multi-corporation: SEC Registration to do business to do business in the Philippines.
For Single Proprietorship: Certificate of Registration with the Department of Trade and Industry (DTI). (For New and Amendment)
Personal Data Sheet (PDS) of the applicant and the management personnel of the storage facility/warehouse. (For New and Amendment)
NBI Clearance of the applicant (For New and Amendment)
Business Permit/PEZA Certificate of Registration
Process flowchart. (For New and Amendment)
Material Safety Data Sheet (MSDS)/Safety Data Sheet (SDS) of controlled chemicals. (For New and Amendment)
Vicinity Map of the factory and storage facility showing distance from the nearest Police Headquarters
Floor/Location Plan of the storage facility (For New and Amendment)
For Metro Manila Applicant: Security Survey Inspection from Chief of Police and Certificate of Inspection from C, EEMD, FEO.
For outside Metro Manila Applicant: Security Survey Inspection from Provincial Director/City Director
Proof of Payment from the Land Bank of the Philippines
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.

Printed Name and Signature of Applicant

DO NOT WRITE BELOW THIS LINE. FOR PNP USE ONLY.
 The 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
The undersigned regretfully DENY THE APPLICATION due to the following:
Incomplete documentary requirements, i.e ; and

Area is not safe pursuant to the Security Survey Inspection Report.

PROVINCIAL DIRECTOR/CITY DIRECTOR

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

Attached are the following documents:

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

CHIEF, REGIONAL CIVIL SECURITY UNIT

The undersigned respectfully RECOMMENDS THE APPROVAL of the application and certifies the completeness of
applicant’s documentary requirements
Attached are the following documents:
Properly labeled pictures (8”x10” in size) of storage facility with PNP Inspecting Team printed in photo paper.
Storage Facility Inspection Report.
The undersigned regretfully DENY THE APPLICATION due to the following:
Incomplete documentary requirements, i.e. ;
Area is not safe pursuant to the Security Survey Inspection Report; and
Storage Facility does not conform to the parameters pursuant to the Storage Facility Inspection Report.

AL M ABANALES
Police Lieutenant Colonel
CHIEF, EXPLOSIVES MANAGEMENT DIVISION

RECOMMEND:
APPROVAL
DISAPPROVAL

PAUL KENNETH T LUCAS

Police Brigadier General
ACTING CHIEF, FIREARMS AND EXPLOSIVES OFFICE

APPROVAL: This license shall be valid for a period of _______ year/s from the date of issuance subject to the
conditions and guidelines imposed under RA No. 9516 and its Implementing Rules and Regulations, other laws, rules
and regulation
DISAPPROVED

DIRECTOR, CIVIL SECURITY GROUP

 Republic of the Philippines
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
CIVIL SECURITY GROUP
Camp BGen Rafael T Crame, Quezon City

EXPLOSIVES MANAGEMENT DIVISION

License to Posses Controlled Chemicals
PURCHASER’S LICENSE (NEW)
a.  Duly accomplished Application Form; 3 VALID IDs (1 Company ID 2 govt, ID) Sec, Certificate / SPA ( GIS )
b.  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 foreign multi-corporation: SEC Registration to do business in the Philippines;
For Single Proprietorship: Certificate of Registration with the Department of Trade and Industry (DTI);
c.  Personal Data Sheet (PDS) of the applicant and the management personnel of the storage facility/warehouse where the controlled chemicals will
be stored (notarized); 3 valid ID’s With( Signature Specimen)
d.  NBI Clearance of the applicant (purpose PNP Requirements);
e.  Business Permit ( Certified True Copy)
f.  Process flowchart signed by the personnel/chemist involved in the processing of chemical (for manufacturer and purchaser only);
g.  Material Safety Data Sheet (MSDS)/Safety Data Sheet (MSDS) of controlled chemicals to be provided by the supplier;
h.  Vicinity map of the factory and storage facility showing distance from the nearest Police Headquarters;
i.  Floor/Location plan of the storage facility;
j.  Properly labeled pictures (8”x10” in size) of storage facility printed in photo paper with caption;
k.  For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of
Inspection from Chief, EEMD, FEO.
For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, Police Provincial Office (PPO)/City Director,
City Police Office (CPO) and Certificate of Inspection from the RCSU or the Provincial Director, PPO/City Director, CPO pending full activation of
the RCSU.
l.  Proof of payment from the Land Bank of the Philippines./ Soft Copy and Tabbings ,

Name of Company: Contact Person:

Address of Storage Facility: Contact No:

STEP 1: Receiver/Verifier REMARKS

Date/Time Received: _____________AM PM

Date/Time Released Date : _______AM PM ________________

Signature over Rank/Name
STEP 2: Scanned by:
Date/Time Received: ____________ AM PM

Date/Time Released Date:_________ AM PM ________________

Signature over Rank/Name
STEP 3: Processed By:
Date/Time Received: ____________ AM PM

Date/Time Released Date: ________AMPM __________________

Signature over Rank/Name
STEP 4: Chief, License and Permit Section
Date/Time Received: ___________ AM PM
Date/Time Released Date: _______AM PM _________________
Signature over Rank/Name
STEP 5: OIC, EMD
Date/Time Received: ___________ AM PM
Date/Time Released Date: _______ _AM PM PLTCOL AL M ABANALES
Signature over Rank/Name
STEP 6: Acting Chief, FEO
Date/Time Received: __________ AM PM
Date/Time Released Date: __________ AMPM PBGEN PAUL KENNETH T LUCAS
Signature over Rank/Name
STEP 7: Chief of Staff, CSG
Date/Time Received: __________ AM PM
Date/Time Released Date _______ AM PM _________________
Signature over Rank/Name
STEP 8: DIRECTOR, CSG
Date/Time Received: __________AM PM
Date/Time Released Date: _________ AMPM __________________
Signature over Rank/Name