REPUBLIC OF THE PHILIPPINES

MARIKINA CITY
BUSINESS PERMITS & LICENSING OFFICE

Business Account No.

No.
Date
REQUEST FORM

1. BUSINESS TRADENAME/CORP.
2. NAME OF OWNER/PRESIDENT/CORP.
3. BUSINESS ADDRESS
4. NATURE OF BUSINESS
5. TEL. NO./CONTACT NO.

Applicant’s Signature over Printed Name

REQUEST FOR:

□ CHANGE OF OWNERSHIP
□ CHANGE OF BUSINESS NAME/TRADENAME
□ CHANGE OF BUSINESS ADDRESS/ LOCATION
□ CHANGE OF BUSINESS STATUS
□ OTHERS (Pls. Specify)

(Applicant should not write below this line)

REQUIREMENTS:

□ Zoning Clearance □ Affidavit

(2nd Floor, City Planning Office) □ Change of Ownership
□ DTI / SEC Registration □ Change of Trade Name
□ Barangay Clearance □ Change of Address
□ Fire inspection Certificate □ Additional Line of Business
(BFP beside Chowking) □ Secretary Certificate
□ Photocopy of Lessor’s Permit □ Board Resolution
and Contract of Lease □ Agreement
□ Others □ Original Business Permit
□ Authorization Letter
□ Valid I.D.
(Onwer Representative New Owner)

Pls. check appropriate box for the particular requirement/s

INSPECTION REPORT

RECOMMENDATION:

Date Inspected

□ APPROVED
□ DISAPPROVED Remarks :

License Inspector

APPROVED :

ATTY. NANCY V. TEYLAN

Chief, BPLO