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ANNEX 1 (Page 1 of 2)
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Republic of the Philippines
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Province of Aklan
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Ati-atihan Town of Kalibo
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BUSINESS PERMITS & LICENSE DIVISION
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APPLICATION FOR BUSINESS AND PERMITS
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INSTRUCTIONS:Tax Year:
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1. Provide accurate information and print legibly to avoid delays. Incomplete application form will be returened to the applicant.
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2. Ensure that all documents attached to this form (if any) are complete and properly filled out.
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I. APPLICATION SECTION
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1. BASIC INFORMATION
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NEW
Mode of Payment:
Yearly
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Date of Application:DTI/SEC/CDA Registration No.:
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TIN No.:DTI/SEC/CDA Registration No.:
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Type of Business:Place of IssueAmout Paid
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Amendment: From
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To
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Are you enjoying tax incentive from any Government Entity?Please specify the entity?
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Name of Taxpayer / Registrant
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Last Name:Bendana, Mary Jade RomuloFirst Name:Middle Name:
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Birthdate (yyyy-mm-dd):Sex:
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Business Name:
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Corporation Name:
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Trade name / Franchise:
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Name of President of Treasurer of Corporation:
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2. OTHER INFORMATION
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Note: For renewal applications, do not fill up this section unless certain information have changed.
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Business Address:
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Postal Code:Email Address:
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Telephone No.:Mobile No.:
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Owner's Address:
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Postal Code:Email Address:
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Telephone No.:Mobile No.:
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In case of emergency, provide name of contact person:
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Telephone / Mobile No.:
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Business Area (in sq. m.):Total No. of Employees in Establishment: 1No. of Employees Residing w/in LGU:
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NameDesignationDate
yyyy-mm-dd
Place of IssueAmount PaidSex M F
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___________________________________________________________
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__________________________________________________________________________________________________________
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__________________________________________________________________________________________________________
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Business with more than four (4) employees are required to submit complete lists on a separate sheet for record and tax purposes.
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Note: Fill Up Only if Business Place is Rented:
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Lessor's Full Name:
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Lessor's Full Address:
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Lessor's Full Telephone/Mobile No.:Lessor's Email Address:
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Monthly Rental:
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3. BUSINESS ACTIVITY
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Line of BusinessNo. of UnitsCapitalizationGross/Sales Receipts (for Renewal)
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(for New Business)EssentialNon-Essential
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Start of Operation (yyyy-mm-dd):
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Gross Sales as of December 31, 20 ____PHP
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Total Expenses as of December 31, 20 ____PHP
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Net Worth as of December 31, 20 ____PHP
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I DECLARE UNDER THE PENALTY OF PERJURY that the foregoing information are true based on my personal knowledge
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and authentic records. Further, I agree to comply qith the regulatory requirement and other deficiencies within 30 days
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from release of the business permit.
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SIGNATURE OF APPLICANT OVER PRINTED NAMEPOSITION / TITLE
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