Republic of the Philippines
DEPARTMENT OF TRADE AND INDUSTRY
Cebu Provincial Office 3/F LDM Building, Legaspi Street, Cebu City
Phone: (6332) 2557084, 2557086 Fax: (6332) 2557609

NEW APPLICATION FOR
MERCHANDISE BROKER or SHIP/SUB-AGENT
(Please submit one copy)

 

Date

Sir:

           In accordance with the provisions of Section 79(b) of the Revised Administrative Code and Sec.3(e) of Act 2728, as amended by Acts Nos. 3715 and 3969 of the Philippine Legislature and Commerce Administrative Order No. 2 and 3, I have the honor to apply for a Certificate of Authority as


_______________________________________

MERCHANDISE;   SHIP;   EXCHANGE;   SUB-AGENT

           For the purpose, I hereby submit the following information

1.  Name of Applicant :
2.  Business Address :
3.  Nationality :
4.  Civil Status :
5.  Age :
6.  Capital :
7.  Telephone No. :
8.  Bank Reference :
9.  If Alien, State ACR No. :
10.  Date Issued :

11. Have you ever been convicted for any violation of law, ordinace or regulation involving cheating, fraud, deceit or wrongful conversion of property, of any crime involving moral turpitude? (If in the affirmative, attached a certified copy of the court proceedings).

12.  State the name and address of the President or Manager (if the applicant is a partnership or corporation)      

13.  Name and Address of the other Offices duly authorized to sign and in behalf of the partnership or corporation
     

14.  Experience(state fully)
     

15.  Describe briefly how you conduct business
     

16.  Do you handle funds and/or merchandise belonging to the public?
     

17.  If the applicant is new, the following clearances must be submitted together with the application:
          1.
Police Clearance
          2.
Fiscal of Justice of the Peace
          3.
Clerk of Court (CFI) of the locality where applicant is presently residing or doing business.



           I hereby declare under oath that the foregoing facts and statement are true and correct to the best of my knowledge and belief and the same have been given voluntarily without fraudulent or deceitful purpose whatsoever.

          IN WITNESS WHEREOF, I have hereunto affixed my signature this day of      20 at ______________________________, Philippines.

       
          SUBSCRIBED AND SWORN to before me this
day of , 20 .Affiant exhibited to me his/her Residence Certificate No. __________ issued on _____________ 20 at _____________________



_______________________
 NOTARY PUBLIC          

Until Dec. 31, 20          
TAN ______________________

Doc. No. _________
Page No. _________
Book No. ________
Series of _________
 




 

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SCHEDULE OF CORRESPONDING FEES AND BONDS

Kinds of License
Fees
Cash or Surely Bond
Merchandise Broker
P 48.80
P 2,000.00
Ship Broker
P 16.50
P 2,000.00
Exchange Broker
P 8.80
P 2,000.00
Sub-agent
P 8.80
None