118 Perea Street, Legaspi Village,

Makati City 1229 DATE

893-8103:750-0047-8236757
inquiry@asc.com.ph; http://www.asc.com.ph
REFERENCE CODE
FORM S1 APPLICATION FOR SCREENING

CLIENT’S INFORMATION
MEMBERSHIP
PANA 4A’s KBP MSAP IMMAP UPMG ASAP OAAP
NON-PANA NON-4A’s NON-KBP NON-MSAP NON-IMMAP NON-UPMG NON-ASAP NON-OAAP

IBA NON-IBA CAAP NON-CAAP OMAG NON-OMAG MORES NON-MORES

COMPANY NAME: Gawad Kalinga Community Development Foundation, Inc

PRODUCT: Enchanted Farm CATEGORY: Non-profit organization BRAND: Different social enterprises

PRESENTOR’S INFORMATION

MEMBERSHIP
PANA 4A’s KBP MSAP IMMAP UPMG ASAP OAAP
NON-PANA NON-4A’s NON-KBP NON-MSAP NON-IMMAP NON-UPMG NON-ASAP NON-OAAP

IBA NON-IBA CAAP NON-CAAP OMAG NON-OMAG MORES NON-MORES

COMPANY NAME: Katha Advertising and Production Company

ADDRESS:

TELEPHONE NUMBER: FAX NUMBER:

LAST NAME: Gamboa FIRST NAME: Joannah

MOBILE NUMBER 09267384157 EMAIL ADDRESS:

MATERIAL INFORMATION

AD TITLE:

REF. CODE OF PREVIOUSLY-APPROVED MATERIAL:

TAGLINE:

TYPE OF MEDIUM:
TV RADIO
ORIGINAL LENGTH ORIGINAL LENGTH
EDITDOWN/DERIVATIVES LENGTH EDITDOWN/DERIVATIVES LENGTH
PORTION BUY/ INTERSTITIAL LENGTH AOB LIVE LENGTH
OBB/CBB LENGTH AOB RECORDED LENGTH
INFOMERCIAL LENGTH LIVE DJ DISCUSSION LENGTH
ENGLISH/FILIPINO ENGLISH/FILIPINO
DIALECT DIALECT
CEBUANO ILONGGO BIKOLANO CEBUANO ILONGGO BIKOLANO
WARAY ILOKANO WARAY ILOKANO
OTHERS OTHERS

CINEMA X PRINT LENGTH (col.) WIDTH (cm.)

ORIGINAL LENGTH
EDITDOWN/DERIVATIVES LENGTH COLLATERALS
ENGLISH/FILIPINO STATIC
DIALECT VIDEO LENGTH
CEBUANO ILONGGO BIKOLANO
WARAY ILOKANO
OTHERS
 OOH LENGTH (ft.) WIDTH (ft.) E-OOH
STATIC LENGTH (px.) WIDTH (px.)
VIDEO LENGTH

X DIGITAL STATIC
X SEARCH ADS SUPERSTITIAL BANNER AD
IN-GAME X DISPLAY AD X ELECTRONIC DIRECT MAIL
OTHERS:

X DIGITAL VIDEO
X INTERNET VIDEO ADS LENGTH MOBILE VIDEO ADS LENGTH

MAIN DOCUMENTS:
STORYBOARD RADIO SCRIPT / COPY LAYOUT

DOCUMENTS SUBMITTED:
DOLE PERMIT DTI PROMO PERMIT DOH-FA PERMIT
EXPIRES ON:___________________ EXPIRES ON:___________________
LABELS/PACKAGING MATERIAL THIRD PARTY RESEARCH DATA NHCP
_____________________________
NTC WAIVER (SIGNED, NOTARIZED PPM
EXPIRES ON:_________________ TESTIMONY FROM ENDORSER) EXPIRES ON:___________________
DIALECT CERTIFICATE CAB / IATA HLURB
BAI MUSIC LICENSE BSP PERMIT
EXPIRES ON:_________________
CERTIFICATE OF NEW CLAIM FPA NO. 1 CLAIM
DATE OF LAUNCH:_____________ EXPIRES ON:___________________ _____________________________
DOH-IAC PERMIT
EXPIRES ON:__________________ BASED ON:____________________

FDA (CERTIFICATE OF PRODUCT REGISTRATON) EXPIRES ON:___________________

VARIANT:______________________________________ EXPIRES ON:______________________________

VARIANT:______________________________________ EXPIRES ON:______________________________

VARIANT:______________________________________ EXPIRES ON:______________________________

VARIANT:______________________________________ EXPIRES ON:______________________________

VARIANT:______________________________________ EXPIRES ON:______________________________

Decision of the ASC Screening and Hearing Panel are based on the Code of Ethics for Advertising and the ASC Manual of Procudures
for screening and filing of complaints and appeals.

Presentor/s are presumed to have read and understood the rules of ASC.

The presentor warrants that he/she is a duly authorized representative of the Advertiser and the he/she voluntarily submits to the
authority of and abides by the rules and procedures of the ASC, inclusive of sanctions that may be imposed as provided therein.
These sanctions or actions may include, but are not limited to deferrals and/or disapprovals of the Screening Panel; and the Cease &
Desist Order (CDO) of the Hearing Panel in case of adjudged complaints on previously-approved materials. The Presentor is ultimately
responsible to inform his/her Advertiser and Advertising Agency of the CDO and to physically retrieved banned material/s and/or
otherwise comply with the decision/CDO.

__________________________________________ __________________________________________
SIGNATURE OVER PRINTED NAME (PRESENTOR) DATE