BTRCP FORM
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Republic of the Philippines
DEPARTMENT OF TRADE AND INDUSTRY
Region VII
PROVINCE OF CEBU

 

  Certificate No. _________
  Date Registered ________
  Expiry Date ___________
  O.R. No. _____________
  Date Issued ___________
O R I G I N A L   A P P L I C A T I O N
(APPLICATION FOR ORIGINAL REGISTRATION OF A FIRM OR BUSINESS NAME OR STYLE
UNDER ACT NO. 3883 AS AMENDED BY ACT NO. 4147 AND REPUBLIC ACT 863)

(Please submit two(2) copies)


_________________________________________________________
FIRM NAME /BUSINESS NAME/STYLE



(To be filled up by DTI Examiner)

 1. OWNER / REGISTRANT
    A. NAME                                                                                                       B. AGE       C. TIN
                  SURNAME                GIVEN NAME                MIDDLE NAME
             _______________       _________________       _________________         _____           _____

    D. RESIDENCE ADDRESS                                                                             E. RES. TEL. NO./S:
        Number: _______    Street: ________    Brgy.: _______________________       _________________
        City/Municipality/District: ______________  Province: _________________       _________________

     F. BUSINESS ADDRESS                                                                               G. BUS. TEL. NO./S:
        
Number: _______    Street: ________    Brgy.: _______________________       _________________
        City/Municipality/District: ______________  Province: _________________       _________________

 
     H. CITIZENSHIP
         1. Filipino      How acquired    1.a Natural Born     1.b. Election     1.c Naturalization
         2.
Foreigners :    State Citizenship _________________________

     I. MARITAL STATUS
        1. Single        2. Married        3. Widowed        4. Other (Specify) ___________

    J. NAME OF SPOUSE (If Married)                          K. NAME OF MANAGER
            Surname         Given Name       M.I.                         Surname         Given Name        M.I.     
        ___________    _____________   _____                  ____________    _____________   _____        

 2. FORM OF OWNERSHIP
     1. Single Prop.       2. Partnership         3. Corporation          4. Others: __________

 3. CAPITALIZATION (To nearest thousand peso)
     a. If Corporation                                                                                b. If Single Prop./Part./Others
                 Authorized           Subscribed            Paid-Up
             P__________        P__________       P__________                         P_________________

 4. NATURE OF BUSINESS
     Code No.:                                                                                 Total No. of Employees: ________
       a. Main Activity     Retailer       Wholesaler        Manufacturer          Dealer
                                  Exporter      Importer            Processor              Producer
                                  Printer         Lessor              Service                  Trader

 5. PRINCIPAL PRODUCTS HANDLED/SERVICES RENDERED
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
     _________________________________________________________________________
 6. FORMER OWNER OF BUSINESS
     a. Business Name: ___________________________       b. Old Certificate No.___________________
     c. Method of Acquisition:
              1. Sale                 2. Assignment                3. Transfer

Has the undersigned been convicted of any crime involving moral turpitude or violation of law relating to trade, commerce and industry?   YES     NO     (If yes, state date, place and nature of offense)
DATE
PLACE
NATURE OF OFFENSE
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________

(Attach certified true copy of the decision of the court of competent jurisdiction
for any crime involving moral turpitude or violation of the law, ordinance or regulation.)

     I hereby agree for a change and/or cancellation of the above mentioned firm name, business name or style in the event that there is already another person, firm or entity lawfully using the same, similar identical name..

     I hereby agree to continue the exhibition of my name or business name or style on a signboard, exhibited in plain view of the public in the premises of my business. I hereby agree to notify DTI in case of transfer to a new location of theexact address of the business establishment, not later than 10 days after its transfer.

     I hereby declare that the date furnished by me in this application form are true and correct to the best of my knowledge and belief and the same have been given voluntarily and without any fraudulent or deceitful purpose whatsoever and that I am aware that any false statement given by me will be a ground for cancellation of my certificate. Further, I also hereby recognize and accept the authority and power of the Department of Trade and Industry or any of its duly designated representatives or agents to check and monitor compliance of my business establishment with various trade and industry laws and its implementing rules and regulations and violations of the same shall be likewise a ground for the cancellation of this certificate.

 

________________________________________              
(Owner's Signature)                                   



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