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Control No.

_______________
Brgy. Sta. Anastacia Tel. Nos.: (043) 405-6020 to 23
Sto. Tomas, Batangas Fax No.: (043) 405-6031

FPIP PARK PASS ID APPLICATION FORM


I. To be filled up by applicant:
Gen-contractor / Sub-contractor : : __________________
Locator : _________________ Service Provider :___________________ (Attached the endorsement from Gen-contractor
stating scope & duration of work)

Project Name / Scope of Work : ___________________________________________________________________

Please check the appropriate box:


 Construction  Machine Setting /  Repair/  Others _______________
(Civil, Structural, Electrical, Equipment Installation Maintenance (Please specify)
Mechanical, Sanitary / plumbing works)

Duration of Work : From: ________________________ To: _________________________


(mm/dd/yy) (mm/dd/yy)

II. List of Personnel : (Please attach separate FPIP ID Application Form for personnel numbering more than 40)
1. 21.
2. 22.
3. 23.
4. 24.
5. 25.
6. 26.
7. 27.
8. 28.
9. 29.
10. 30.
11. 31.
12. 32.
13. 33.
14. 34.
15. 35.
16. 36.
17. 37.
18. 38.
19. 39.
20. 40.

III. Endorsed by:

General Contractor’s Authorized signature over printed name Locator’s Authorized signature over printed name

IV. For Park Administration:


Checked and Verified by: Received Payment by: Encoded by:
Date / Time Date / Time
Date and Time
Total Approved Application: PR No. :

V. Requirements
A. 8 days up to 30 days duration B. 31 days up to 90 days duration C. For ID renewal
1. Fully accomplished FPIP ID Form 2
1. Fully accomplished FPIP ID Form 2 1. Fully accomplished FPIP ID Form 2. (Contractor /
(Contractor / Service Provider ID Application Form)
(Contractor / Service Provider ID Application Service Provider ID Application Form) Please
Form) 2. 1 pc. 2x2 ID picture (latest)
3. Photocopy of Company ID (Valid and Current, indicate Previous ID Control number.
2. 1 pc. 2x2 ID picture ( latest ) * No ID picture required if previous
front and back)
3. Photocopy of any 1 of the following photos submitted is less than 1 year old
valid IDs: Company ID, SSS ID, TIN ID, 4. Photocopy and original (for verification) NBI or
Police Clearance from Sto. Tomas or Tanauan 2. Photocopy and original (for verification) NBI or
Philhealth ID, PRC ID, Passport, Drivers Police Clearance from Sto. Tomas or Tanauan
License depending on location of project / activity
depending on location of project / activity
Note:
1. Applications will not be received by FPIP with incomplete / insufficient requirements.
2. Other documents may be required by FPIP depending on nature of application.
3. Locator’s / General Contractor’s authorized signature is subject for verification based on the latest submitted list of Authorized Signatory to FPIP.
4. Please see and sign Data Privacy Act Notice at the back of application form.

Rev. 03 (OPN-PF-SEC)
08/01/2018
DATA PRIVACY NOTICE

By filling-up, signing and submitting this form together with your attached requirements, you are
consenting to the collection, processing, use and retention of your personal data based on the Privacy
Policy of the Company. Your personal information is also collected through phone calls, emails, SMSs
or verbal communication with our authorized representatives, as applicable. In particular, we are using
your information to process your access permit and monitor entry to the park in connection to your
performance of work, to comply with government requirements, and to perform such other
processing that may be required in the course of business. You attest that all such personal data is
accurate, complete and up-to-date.

As a general rule, we are not allowed to share your data to third party, except in limited circumstances.
By giving your consent, you authorize the Company to disclose your personal data to accredited/affiliated
or independent/non-affiliated third parties, as necessary for the proper execution of processes related to
the declared purpose, and when the use or disclosure is reasonably necessary, required or authorized by
or under law. However, such third parties may only use personal data for the purpose disclosed and may
not use it for any other purpose.

The Company strictly enforces its Privacy Policy and have implemented technological, organizational,
and physical security measures to protect your information. The Company stores electronic and physical
document in both local and off-shore facilities in accordance with the Company’s Retention Policy. As a
data subject, you have the right to be informed, to object, to access, to rectify or correct erroneous data, to
secure data portability, and to be indemnified for damages. The Company’s decisions to provide access,
consider requests for correction or erasure, and address objection to process personal data as it appears in
the Company’s official records, are always subject to applicable and relevant laws and/or the DPA, its
IRR and other issuances of the NPC. Should you have any inquiry, feedback, and/or complaints to the
Company’s Privacy Policy, you may reach our Data Protection Officer at fpipdpo@fpip.com.

__________________________________
General Contractor’s Authorized
Signature and printed name

Rev. 03 (OPN-PF-SEC)
08/01/2018