Application for Business License Revised January 2010
Application Form for Business Permit For the year 201_ City of Butuan www.butuan.gov.ph
NEW
RENEWAL
TRANSFER; OWNERSHIP Annually
MODE OF PAYMENT:
LOCATION Semi-Annually
Date of Application: DTI/SEC Registration/Date Reference No./Current Permit No. TIN NO. Type of Ownership: ( ) Single Proprietor ( ) Partnership ( ) Corporation Are you enjoying tax incentive from any Government Entity? ( ) Yes ( ) No Pls. specify the entity. Name of Taxpayer Last Name:
( ) Others
First Name:
Birth Date: Business/Name:
Middle Name:
Birthplace:
Gender:
Civil Status:
Trade Name/Franchise: Business Activity Details: Main Number of Employees: _____ ( ) Male Name of Representative: Business Address
(
Branch
Franchise
Address: Owner’s Address House No. Street / Purok Building Name Barangay City/Municipality Province Tel. No. /Cellno. Email Address
Building Name Barangay City Province Tel. No. /Cellno. Email Address Property Index Number (PIN): Business Area (In sq m): If Place of Business is Rented, please identify the following:
Lessor’s Address: Administrator (If Owner is not available) Name:
Nature of Business
Monthly Rental:
LESSOR’S NAME
First Name
Code
) Female
House No. Street / Purok
Last Name
ADDITIONAL Quarterly
Middle Name Barangay:
Address: BUSINESS ACTIVITY No. of Capital (For New) Units/ Branches
Gross Sales/Receipts For preceding year
I HEREBY ATTEST to the correctness and accuracy of the information that are presented above and undertake that I will comply with the following conditions in order to operate the above described business activity, to wit: 1. 2. 3. 4.
Pay all taxes and fees appurtenant to my business under existing ordinances. Comply with the pertinent provisions of Ord. No. 894-92 and other related rules and regulations. Exercise due care and diligence in maintaining hygiene and sanitation in my business establishment. Observe, when and where applicable, the requirement of the Social Security System (SSS), PhilHealth, Pag- IBIG, National Food Authority and National Internal Revenue Code. 5. Comply with the requirements of the National Building Code and the requirement of the Fire Department. I will submit and comply with all other requirements, viz; Community Tax Certificate (CTC), Barangay Clearance, Bureau of Fire Protection (BFP), Building (CAO), Zoning, PhilHealth, BIR, SSS, Pag-IBIG and other Departments/Offices and Agencies concerned, in their post licensing evaluation/monitoring of my business establishment during the current taxable year and/or which shall commence within thirty (30) days from the issuance of my Business Permit, which can be revoked by the Office of the City Mayor, for non-compliance of any of the above conditions.
_____________________________________ (Signature over Printed Name of Applicant/Taxpayer) Recommending Approval:
Approved:
EMMA LUZ U. ASIS Local Revenue Collection Officer II Officer In Charge – BPLD
For New Application pls. refer at the back.
ENGR. RONNIE VICENTE CONDE LAGNADA City Mayor
---------------------------------- (For New Business Applicants) ---------------------------Description Barangay Clearance Location Clearance Sanitary/Health Clearance Occupancy Permit Fire Safety Inspection Certificate Others, please specify:
Office/Agency Barangay Zoning Admin. City Health Dept. Bldg. Official BFP
Date of Payment/Issued
VERIFIED BY: (BPLO Staff)