IMPORTANT: FILL DATA REQUIRED COMPLETELY, ACCURATELY AND LEGIBLY. ALL ENTRIES MUST BE TYPEWRITTEN AND WILL BE ENCODED IN THE DATABASE SYSTEM OF SOSIA. BUSINESS PROFILE BUSINESS NAME: COMPANY E-MAIL ADDRESS: BUSINESS ADRESS: CONTACT NR/ CP NR:
[ ] PRIVATE DETECTIVE [ ] COMPANY SECURITY FORCE NATURE OF BUSINESS: [ x ] SOLE PROPRIETORSHIP [ ] PARTNERSHIP [ ] CORPORATION BRANCHES: NUMBER OF BRANCHES: INVESTMENT CAPITAL: ____ Luzon ____ Visayas ___ Mindanao ( ) 1 ( ) 2 ( )3 ( ) 4 P1,000,000.00 LICENSE TO OPERATE APPLIED FOR: ( )Temporary(New) ( ) Temporary - Regular (x) Regular ( ) Temporary/1st Extension ( ) Temporary/2nd Extension MANAGEMENT PROFILE Name of Licensee: S.O. License Validity: Address: Contact Nos. A. Administration/Operation Name License Validity Position SECURITY DIRECTOR SECURITY STAFF DIRECTOR FOR OPERATION SECURITY STAFF DIRECTOR FOR ADMINISTRATION B. Board of Directors (for Corporation only) Name Position
SECURITY PERSONNEL and FIREARMS PROFILE
Nature of Profession Number FAs Caliber/Make Number
LICENSE PROFILE (For old Applicant only)
License to Operate Number Authority and Date Granted Expiry Date
CRIMINAL/ ADMINISTRATIVE CASE PROFILE
Has licensee/agency been charged criminally/administratively/civilly in any court or quasi-judicial
body within the Philippines? ______ . ( If Yes, please specify below) Nature of Case Where and When Filed Disposition
CERTIFICATION AND UNDERTAKING
I hereby certify that, all statements provided and documentary requirements attached herein are true, correct, valid and authentic and any misdeclaration/falsity stated therein shall be a basis for the cancellation/revocation of my License to Operate (LTO) without prejudice to the filing of criminal and/or civil case against me. I hereby undertake to renew the License to Operate (LTO) two (2) months before the date of expiration of the same. I understand that, pursuant to Section 11 (c) part 2, Rule IV of 2003 Revised Implementing Rules and Regulation of R.A. No. 5487, as amended, that failure on my part to renew the LTO sixty (60) days after the expiry date, shall cause its automatic cancellation and subsequent issuance of Cease to Operate Order against PSA. Consequently, all firearms shall be deposited in the storage of FEO or nearest FESAGS or Police Station pursuant to RA 10591. SUBSCRIBED AND SWORN TO BEFORE ME THIS _____ DAY OF _____________________ APPLICANT EXHIBITED TO ME _____________________ HIS/ HER CTC NO. ______________ ISSUED IN __________ LICENSEE _______________ ON ______________. DOC NO: _____ PAGE NO:_____ BOOK NO:_____ Series of _____ NOTARY PUBLIC Form-AL-01
ME HIS/HER COMMUNITY TAX CERTIFICATE NO.
____________ ISSUED IN __________________ ON ________________________.
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