BTRCP Form No. 22 (Revised 1987) CONTROL NO.

Republic of the Philippines DEPARTMENT OF TRADE AND INDUSTRY BUREAU OF TRADE REGULATION AND CONSUMER PROTECTION Trade and Industry Bldg., 361 Sen. Gil J. Puyat Ave. Makati, Metro Manila

PLEASE READ INSTRUCTIONS/ REQUIREMENTS AT THE BOTTOM, BEFORE FILLING UP APPLICATION.                    - - - -    - -   FOR BTRCP USE ONLY   Date Rec'd   Date Reg.   Certificate No.

R E N E W A L
APPLICATION FOR RENEWAL REGISTRATION OF A FIRM OR BUSINESS NAME OR STYLE
UNDER ACT NO. 3883, AS AMENDED BY ACT NO. 4147 AND REPUBLIC ACT NO.863
(To be accomplished in Quadruplicate)


_________________________________________________________
FIRM NAME /BUSINESS NAME/STYLE



(To be filled up by DTI Examiner)
DATE OF ORIGINAL REGISTRATION___________________

1. IDENTIFICATION     A. DATE LAST REGISTERED                         B. CERTIFICATE No. (Last Registered)     _____________________                           ____________________________  2. 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.              ___________    _____________   _____                  ____________    _____________   _____          3. FORM OF OWNERSHIP      1. Single Prop.       2. Partnership         3. Corporation          4. Others: __________  4. CAPITALIZATION (To nearest thousand peso)      a. If Corporation                                                                        b. If Single Prop./Part./Others                               Authorized     Subscribed    Paid-Up       PRESENT         P______        P______       P______                PRESENT     P________________       LAST REPORTED                                                                   LAST REPORTED       TO BTRCP        P______        P______       P______                TO BTRCP   P________________  5. NATURE OF BUSINESS                                       a. Main Activity     Retailer       Wholesaler        Manufacturer          Dealer                                   Exporter      Importer            Processor              Producer                                   Printer         Lessor              Service                  Others _______        b. Principal Product/ Services Handled      _________________________________________________________________________      _________________________________________________________________________      _________________________________________________________________________      _________________________________________________________________________  6. BUSINESS OPERATION     DATE BUSINESS ORIGINALLY BEGAN                TOTAL NUMBER OF EMPLOYEES (Last Payroll)          _____________________________                 ____________________________________

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 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 ESTABLISHMENT.

     I HEREBY AGREE TO NOTIFY THE BTRCP/DTI IN CASE OF TRANSFER TO A NEW LOCATION, OF THE EXACT ADDRESS OF THE BUSINESS ESTABLISHMENT, NOT LATER THAN 10 DAYS AFTER ITS TRANSFER.

     I, ____________________________________, HEREBY DECLARE THAT THE DATA 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 SAID FALSE STATEMENT GIVEN BY ME WILL MAKE ME CRIMINALLY LIABLE UNDER THE PROVISIONS OF THE REVISED PENAL CODE WITHOUT PREJUDICE TO THE CANCELLATION OF MY CERTIFICATE.

 

________________________________________              
(AFFIANT)