FormNo.

01

DepartmentofTransportation&Communications
LANDTRANSPORATIONOFFICE
EastAvenue,QuezonCity

NEWAPPLICATIONFORACCREDITATIONOF
MANUFACTURER/ASSEMBLER/IMPORTER/REBUILDER/DEALER
OFMOTORVEHICLESAND/ORITSCOMPONENTS

DATE:_____________________

BUSINESSNAME:___________________________________________________________________
BUSINESSADDRESS:___________________________________________________________________
_____________________________________________________________________________________
CONTACTNO. :_________________________________

CLASSICATION: ManufacturerChassis
bodyOther___________
Assembler 4Wheels3Wheels2WheelsOther____________
ImporterBrandNewMV(CBU)UsedorsecondhandMV

UsedComponentsOther__________
Rebuilder TruckBusOther___________
DealerCarUVSUVBus
TruckTrailerMotorcycleComponent

Others___________

DOCUMENTARYREQUIREMENTS
GeneralRequirements
()Certifiedtruecopy/iesofSecuritiesandExchangeCommissionCertificateofRegistrationand
ArticlesofIncorporation/PartnershipandByLawsforCorporation/Partnership
()Certifiedtruecopy/iesofDTICertificateofBusinessNameofRegistrationforSoleProprietorship
()Certifiedtruecopy/iesofMayorsPermitfor:
()PlantifapplyingforManufacturer&Assembler

()WarehouseifapplyingforImporter
()RebuildingCenterifapplyingforRebuilder
()DisplayCenterifapplyingforDealer
()FinancialStatement(StatementofAssetsandLiabilities)dulycertifiedbyCPA
()BIRCertificateofRegistration
()SSSCertificateOfMembership
()LocationMap
()PictureofEstablishment
()ContractofLease/TransferCertificateofTitle
()Undertakingunderoathbysoleproprietororhighestrankingcompanyofficialthatall

StockstobereportedarecompliantwithallPhilippinelaws,rulesandregulations
relatingtomanufacture,assembly,importation,registrationanduseinthePhilippines.

AdditionalRequirementforAssembler
()Certifiedtruecopy/iesofDTIBoardofInvestment(BOI)CertificateofMembership

AdditionalRequirementforRebuilder
()Certifiedtruecopy/iesofDTICertificateofAccreditationofRebuildingCenter

_______________________________________

__________________________
PrintedName&SignatureofApplicantand/or

Designation
AuthorizedRepresentative

SUBSCRIBEDANDSWORNtobeforemethis___dayof_________________,affiantexhibitingtome
his/herResidenceCertificateNo._______________issuedat_______________on____________
Doc.No.______
PageNo.______

BookNo.______
Seriesof______

NOTARYPUBLIC