DEPARTMENT OF TRADE AND INDUSTRY
Cebu Provincial Office 3/F LDM Building, Legaspi Street, Cebu City
Phone: (6332) 2557084, 2557086 Fax: (6332) 2557609
MERCHANDISE BROKER or SHIP/SUB-AGENT (Please submit one copy)
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
SHIP; EXCHANGE; SUB-AGENT
the purpose, I hereby submit the following information
Name of Applicant
If Alien, State ACR No.
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
(If in the affirmative, attached a certified copy of the court
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:
of Justice of the Peace
of Court (CFI) of the locality where applicant is presently
residing or doing business.
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.
WITNESS WHEREOF, I have hereunto affixed my signature
at ______________________________, Philippines.
AND SWORN to before me this
.Affiant exhibited to me his/her Residence Certificate No.
__________ issued on _____________ 20
Until Dec. 31, 20
Page No. _________
Book No. ________
Series of _________