Haz Waste and Chemicals - Forms

PMPIN ABBREVIATED FORM
Section A: Premise Information CBI ( )
1. Premise Name (in case of joint submission, the principal premise is required to
complete this section)
2. Premise Physical Location and Telephone Number
3. Name of the Responsible Authority
4. Mailing Address and Telephone/Fax Number
5. Circle: Manufacture Import
Section B: Chemical Identification Information CBI ( )

6. Chemical Name:
CAS Registry Name IUPAC Common Name
7. CAS Number (if available)
8. RTECS Number (if available)
9. Molecular Formula
10. Synonyms for the New Chemical
11. Trade Name of the New Chemical
Section C: Production, Import and Intended Use CBI ( )
12. Total quantity produced or imported in the first 12 months (Kg)
13. Estimate the quantity of the new chemical used in any of the
following categories (kg):
Site Limited Industrial Commercial Consumer
Section D: Regulatory Status in Other Countries
14. Country Name:
15. Regulatory Status of the New Chemical in that country:
16. Is MSDS available for the new chemical in the country referred: Yes (attach MSDS) No
(Use a separate page if there are more than one country)

PMPIN ABBREVIATED FORM
Section E: Statement on Physicochemical Characteristics (if available)
Boiling Point Vapor Pressure

Melting Point Purity
S. Gravity Water/Octanol Partition
Coefficient
Solubility in Water
Section F: Statement on Toxicological Effects of the Chemical
(Refer to instruction for the type of test results required)
Section G: Statement on Environmental Effects of the Chemical
Section H: List other companies and their address if this is a joint submission
Section I: List of Attachments
Certification:
I hereby certify that all the information provided in this form and the support
documents attached are true and accurate.
Signed:
Name: Position: Date:

PMPIN ABBREVIATED FORM INSTRUCTIONS
Confidential Business Information (CBI)

Mark X if you claim CBI for any of sections: A,B, or C. Please provide in separate page
justification for claiming CBI and attach.
Section A
Fill in the information about the premise/firm that is considered the principal submitter of
this form.
Section B
Provide the chemical identity information. Consult DENR if you need assistance in
obtaining the information required. It will expedite the review process if synonyms or
analogues to the new chemicals can be presented. Otherwise attach the results of an X-ray
diffraction (non-organic chemicals) or Mass Spectrum (organic chemicals) analysis to
enable DENR review committee for correct identification of the chemical notified.
Section C
Estimate the total quantity of new chemical to be manufactured or imported during the first
12 months of operations. Under subsection 13 estimate how much of the intended
production or import will be used in any of the four categories on an annual basis (the total
should be equal to the figure provided in subsection 12). Industrial use is defined as any
use during manufacturing and process operations. Commercial use is interpreted as any use
aiming at consumer services.
Section D
Submission of the Abbreviated Form is primarily based on the premise that the new
chemical is used in another country with a similar chemical review process as in the
Philippines. It is important that the notifier provides all the information required in this
section to expedite the review process.
Section E
Provide any document describing the physicochemical characteristics of the new chemical
notified. Documented research data from other countries will be helpful. Notifiers with
such information will assist DENR to expedite the review process.
Section F
Present a short description of potential toxicological effects of the new chemical (if any)
and provide any document describing those effects. Documented research data and journal
articles from other countries will be helpful. Health effects data may include
carcinogenicity, sensitization, acute toxicity and irritaation. Notifiers with such information
will assist DENR to expedite the review process.
Section G
Present a short description of potential environmental effects of the new chemical (if any)
and provide any document describing those effects. Documented research data and journal
articles from other countries will be helpful. Environmental effects may include acute and
chronic toxicity to animals (fish in particular) and terrestrial plant toxicity. Information
concerning the fate of the chemical upon release to environment will be important.
Notifiers with such information will assist DENR to expedite the review process.
PMPIN DETAILED FORM
Section A: Premise Information CBI ( )

13. Premise Name
14. Premise Physical Location and Telephone Number
15. Name of the Responsible Authority
16. Mailing Address and Telephone/Fax Number
17. Circle: Manufacture Import
Section B: Chemical Identification Information CBI ( )

18. Chemical Name:
CAS Registry Name IUPAC Common

Name
19. CAS Number (if available)
20. RTECS Number (if available)
21. Molecular Formula
22. Synonyms for the New Chemical
23. Trade Name of the New Chemical
Section C: Production, Import and Intended Use CBI ( )
24. Total quantity produced or imported in the first 12 months (Kg)
13. Estimate the quantity of the new chemical used in any of the
following categories (kg):
Site Limited Industrial Commercial

Consumer
Section D: Occupational Exposure

CBI ( )
Type of Activity Number of Workers Duration of exposure (h/d)
Section E: Estimate Environmental Release and Disposal of the New Chemical

CBI ( )
Quantity (kg) Media of Release Control Measures Planned
PMPIN DETAILED FORM
Section F: Statement on Toxicological Effects of the Chemical
14. Country Name:
15. Regulatory Status of the New Chemical in that country:
16. Is MSDS available for the new chemical in the country referred:
Yes (attach MSDS) No
(Use a separate page if there are more than one country)
Section G: Physiochemical Test Results
17. Tests Conducted by (Name and Address of the Laboratory):
18. Test Results Attached Yes No
Section H: Toxicological Effects Test Results
19. Tests Conducted by (Name and Address of the Laboratory)
Section I: Environmental Effects Test Results
21. Tests Conducted by (Name and Address of the Laboratory)
Section J: List other companies and their address if this is a joint submission
Section K: List of Attachments
Certification:
I hereby certify that all the information provided in this form and the support documents
attached are true and accurate.
Signed:
Name: Position: Date:
PMPIN DETAILED FORM INSTRUCTIONS
Confidential Business Information (CBI)

Mark X if you claim CBI for any of sections A, B, or C. Please provide in separate page justification for claiming CBI and
attach.
Section A
Fill in the information about the premise/firm that is considered the principal submitter of this form.
Section B
Provide the chemical identity information. Consult DENR if you need assistance in obtaining the information required. The
results of an X-ray diffraction (non-organic chemicals) or Mass Spectrum (organic chemicals) analysis must be submitted along
with this form to enable DENR review committee for correct identification of the chemical notified.
Section C
Estimate the total quantity of new chemical to be manufactured or imported during the first 12 months of operations. Under
subsection 13 estimate how much of the intended production or import will be used in any of the four categories on an annual
basis (the total should be equal to the figure provided in subsection 12).
Section D (not applicable to importers)

Estimate the type of activities the workers will be engaged in the use and production of the new chemical. For each type of
activity provide information about the maximum number of workers and maximum hours per day that they will be exposed to the
new chemical.
Section E (not applicable to importers)

Estimate the quantity of the new chemical that will possibly be released through air, surface water, groundwater, and soil. Also,
provide a brief statement regarding release control measures planned.
Section F
Submission of the information concerning the regulatory status of this chemical in other countries will expedite the review
process.
Section G
Provide any test results on the physicochemical characteristics of the new chemical notified. Documented research data from
other countries will be helpful. Notifiers with such information will assist DENR to expedite the review process. The test results
should include:
Boiling Point, Vapor Pressure, Melting Point, Purity, S. Gravity, Water/Octanol partition Coefficient, Solubility in Water, and
solubility in organic compounds.
Section H
Present the test results of potential toxicological effects of the new chemical and provide any document describing those effects.
Submit documented research data and journal articles from academia in the Philippines and other countries. When you submit
the test results, ensure that the full name and address of the laboratory which conducted the tests in the Philippines or in other
countries are clearly indicated. The health effects data may include carcinogenicity, mutagenicity, teratogenicity, sensitization,
acute and chronic toxicity and irritation. Notifiers with such information will assist DENR to expedite the review process.
DENR may require full meeting of the new chemical notified if it determines that the information submitted is not adequate to
assess the potential risk of the new chemical.
Section I
Present the test results of potential environmental effects of the new chemical and provide any document describing those effects.
Submit documented research data and journal articles from academia in the Philippines and other countries. When you submit
the test results ensure that the full name and address of the laboratory which conducted the tests in the Philippines or in other
countries are clearly indicated. Environmental effects may include acute and chronic toxicity to animals (fish in particular) and
terrestrial plant toxicity. Information concerning the fate of the chemical upon release to environment will be important and must
be submitted if available. Notifiers with such information will assist DENR to expedite the review process. DENR may require
full testing of the new chemical notified if it determines that the information submitted is not adequate to assess the potential risk
of the new chemical.
DENR ________
REGION ______
ASBESTOS REGISTRATION FORM
I. GENERAL INFORMATION
1. COMPANY NAME
___________________________________________________________________________
OFFICE ADDRESS
___________________________________________________________________________
___________________________________________________________________________
PLANT ADDRESS/STORAGE FACILITY (If different from the above)

___________________________________________________________________________
___________________________________________________________________________
2. TELEPHONE NUMBER ______________________________________________________
FAX NUMBER _____________________________________________________________
3. CONTACT PERSON/DESIGNATION
___________________________________________________________________________
___________________________________________________________________________
4. CATEGORY OF APPLICANT/TYPE OF BUSINESS
□ Importer
□ Manufacturer
□ Owner of industrial, commercial and institutional structures
With sprayed-on and friable asbestos
□ Waste Service Provider (transporter, treater, disposer)
5. STATUS OF COMPLIANCE TO ENVIRONMENTAL AND OTHER PERMITS
Permit No. Date Issued

□ Environmental Compliance Certificate . (Validity Date)
□ Permit to Operate (air)
□ Permit to Operate (water)
□ TSD Permit
□ SEC Registration
□ Business Permit
II ASBESTOS SPECIFIC INFORMATION (For all categories, if applicable)
A. IMPORTATION/PRODUCTION INFORMATION
1. AVERAGE - ANNUAL/ QUANTITIES IMPORTED/DISTRIBUTED AND USED
___________________________________________________________________________
2. QUANTITY OF PRODUCTS PRODUCED (In kilos/year) _____________________
3. QUANTITY OF BULK ASBESTOS (In kilos/year) ___________________________
4. LIST OF ASBESTOS CONTAINING PRODUCTS IMPORTED/DISTRIBUTED

AND/OR MANUFACTURED
________________________________________________ ________________ton/kg.
________________________________________________ ________________ton/kg.
________________________________________________ _______________ton/kg.
________________________________________________ _______________ ton/kg.
5. TYPE OR VARIETY OF ASBESTOS _________________________________

6. PROCESS FLOW CHART AND TYPE OF ACTIVITY EXPOSED TO ASBESTOS (Use
additional sheet, if necessary)
7. QUANTITY OF ASBESTOS WASTE PRODUCED/GENERATED ANNUALY/QUATERLY

□ Friable (In Kilos/year) _____________________
□ Non-Friable (In kilos/year) _________________
2
III. MANAGEMENT INFORMATION
1. TOTAL NUMBER OF WORKFORCE ___________________
3 2. NUMBER & CATEGORY OF EMPLOYEES THAT MAY BE EXPOSED TO

4 ASBESTOS RELEASES. ASSESS THE NATURE AND EXTENT OF
EXPOSURE TO ASBESTOS (INCLUDE MAXIMUM NUMBER OF WORKERS AND
MAXIMUM HOURS PER DAY OF EXPOSURE AND ANY MDEICAL SUPERVISION
OF PERSONS WHO ARE EXPOSED TO ASBESTOS)
5 ______________________________________________________________________
6 3. EDUCATION AND TRAINING PROGRAM ORGANIZED FOR ASBESTOS

HANDLING OVER THE LAST THREE YEARS (NO.) _______________________
DETAILS OF THOSE TRAINING PROGRAMS ORGANIZED?
Title/Name Organizer Date/Duration

______________________________ _______________________ __________________
______________________________ _______________________ __________________
______________________________ _______________________ __________________
______________________________ _______________________ __________________
IV. PREVENTIVE AND CONTROL MEASURES
1. DESCRIBE THE GENERAL PREVENTIVE AND CONTROL PROGRAM OF THE

COMPANY FOR ASBESTOS INCLUDING ITS VENTILATION SYSTEM.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
2. DESCRIBE HOUSEKEEPING PRACTICES DEVELOPED AND IMPLEMENTED

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3. IDENTIFY & DESCRIBE EQUIPMENT USED

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
4. LIST OF RESPIRATORY PROTECTIVE EQUIPMENT AVAILABLE FOR PERSONNEL/

WORKER DURING HANDLING AT THE PREMISE AND DURING TRANSPORTING.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
5. DESCRIBE IN BRIEF THE CONTINGENCY PROCEDURES/PLAN (In case of emergency)

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
V. TREATMENT, STORAGE & DISPOSAL INFORMATION (For all categories)
1. DESCRIBE STORAGE METHODS, PROCEDURES, FACILITIES AND LOCATION.

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
2. DESCRIBE PROCEDURES FOR TRANSPORTATION OF RAW FIBER AND FINISHED

PRODUCTS.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3. ANY PLANNED RENOVATION(S) AND/OR REMOVAL OR MAJOR IMPROVEMENTS

TO BE MADE IN THE NEXT 12 MONTHS?
o Yes
o No
4. LIST OF ATTACHMENTS
0 Pertinent Environmental Permits 0 Process Flow Chart
0 Results of air monitoring data of asbestos 0 Bill of Lading of all shipment per year
0 Certification of liabilities of parties to compensate for damage to properties and life incase of
emergencies & accidents.
0 Photo documentation of the plant's operation, storage facilities and others.
VI. NOTARIZED CERTIFICATION
THE UNDERSIGNED CERTIFY THAT THE INFORMATION PROVIDED IN THIS FORM IS

TRUE AND ACCURATE.
NAME ___________________________________
DESIGNATION/POSITION___________________
SIGNATURE _________________________ DATE____________________________

CHEMICAL CONTROL ORDER REGISTRATION FORM
(Please Type or Print Answers)
1. Name of Applicant/Company : ___________________________________

_____________________________________________________________
2. Category of Applicant : (Check one or more categories, as appropriate)
o importer
o distributor
o user
o transporter of chemical
o waste transporter
o waste treater
o waste disposer
3. Type of chemical(s) CAS No. and chemical compound (s) to be

handled and the corresponding Chemical Abstract Service (CAS) No.
_____________________________________________________________
_____________________________________________________________
4. Business Address:
_____________________________________________________________
_____________________________________________________________
Storage Facility /Plant Address (if different from the above)
_____________________________________________________________
_____________________________________________________________
5. Telephone No. : ____________________________

Facsimile No. : ____________________________
E-mail address : ____________________________
6. Contact Person : _____________________________

Designation : ______________________________
7. Business Permit No. Validity Date Region/City
________________ ______________ ___________
SEC Registration No. Validity Date Region/City
_________________ ______________ ___________

8. Annual Chemical(s) Requirement (kg or MT) ______________________
____________________________________________________________
9. Status of Compliance to Environmental Permit
Date of issuance/ Region/City

validity date
ECC No. _______________ __________ ____________

Permit to Operate Number
air _______________ __________ ____________
water ______________ __________ ____________
10. Attachments (Please attach a photocopy of the following)
Business Permit
SEC Registration
Chemical Management Plan
Copy of Environmental Permits
11. Certification:
I certify that the data and information hereto stated in this form and attachments
are true and correct. I understand that any false or misleading statements may result in
permanent denial of my/my company’s application or cancellation of my/my company’s
registration.
Date of application : _________________________________

Signature of Authorized Person : _________________________________
Printed Name : _________________________________
Title/Designation : ________________________________
_____________________________________________________________________
DO NOT WRITE IN THIS SPACE
Chemical(s) Applied For : ________________________________

Endorsement and Inspection Report Date:____________________
Information checked by : ________________________________
Fee : ________________ Official Receipt No. ___________
First Verification Date : _________________
Second Verification Date : _________________
Republic of the Philippines
Department of Environment and Natural Resources
ENVIRONMENTAL MANAGEMENT BUREAU
PHILIPPINE OZONE DESK
2nd Floor, Human Resources Development Training Center
DENR compound, Visayas Avenue, Diliman, Quezon City
Tel. Nos.: 925-2344 / 928-1244
E-mail Add.: ozonsave@phil-ozone-desk.gov.ph
APPLICATION FOR REGISTRATION FOR THE IMPORTATION OF

OZONE-DEPLETING SUBSTANCES AND ALTERNATIVE CHEMICAL SUBSTANCES
Important Note:
Date Applied : _____________
Accomplish this form in three (3) copies, each with a
photocopy of the previous EMB Certificate of Registration for Registration Number : _____________
the Importation of ODS and Alternative Chemical
Substances (if applicable). To facilitate processing, all Document Number : _____________
information must be supplied accurately.
I. Applicant’s (Juridical) Name: _______________________________________________________________

II. Business Address: _________________________________________ Contact Number: ______________
III. Point Person : __________________________________ Contact Number: ______________
Position / Designation : __________________________________
IV. Training / Seminar / Workshop Attended by the Point Person (attach a photocopy of the Certificate)
Date: Title of Training / Seminar / Workshop: Conducted by:
_________________ _______________________________________ _____________________

V. SEC / DTI Registration Number (attach a photocopy of SEC/DTI Registration Certificate with list of officers):
______________________________________________________________________________________
VI. Type of Importer: (please mark X the appropriate box/boxes and fill-up the fields corresponding to it/them)
Importer - Distributor
Address of Storage Facility: __________________________________ Contact Number: ______________

Importer - End-user
VII. Environmental Compliance Certificate (ECC) / Certificate of Non-Coverage (CNC) Number (attach a photocopy
of the ECC / CNC): _____________________________________________________________
VIII. Profile of Business: ______________________________________________________________________
IX. Data on Substance Subject to Importation:
Brand / Trade / Commercial Name/s (attach the appropriate Material Safety Data Sheet or MSDS for each):
______________________________________________________________________________________
Intended Use: __________________________________________________________________________
(please mark X the appropriate box and fill-up the fields corresponding to it)
Substance of Single Chemical Composition
Generic Name: _____________________________ Chemical Formula: _____________
Substance of Multiple Chemical Composition Blend Generic Name: __________
Percent: ______ Generic Name: _____________________________ Chemical Formula: _____________

X. Size of Storage Area (in m2): ______________________________________________________________

XI. Chemical Handler: __________________________ Position / Designation: ________________________
XII. Training / Seminar / Workshop Attended by the Chemical Handler (attach a photocopy of the Certificate)
Date: Title of Training / Seminar / Workshop: Conducted by:
_________________ _______________________________________ _____________________
I acknowledge that this application form is a legally binding document, and I declare, under the
penalties of perjury, that the same has been accomplished in good faith, verified by me, and, to the best of my
knowledge and belief, is true and correct pursuant to the regulations issued under authority thereof.
Republic of the Philippines
___________________________________
PHILIPPINE OZONE DESK
(Authorized
2nd Floor, Human Resources Development Signature over Printed Name)
Training Center
DENR compound, Visayas Avenue, Diliman, Quezon City
Tel. Nos.: 925-2344 / 928-1244
E-mail Add.: ozonsave@phil-ozone-desk.gov.ph
FORM A
APPLICATION FOR PRE-SHIPMENT IMPORTATION CLEARANCE OF
OZONE-DEPLETING SUBSTANCES AND ALTERNATIVE CHEMICAL SUBSTANCES
Original Copy
Important Note:
Accomplish this form in three (3) copies, each with a Date Applied : _____________
photocopy of Proforma Invoice. To facilitate processing, all
information must be supplied accurately. Please take note of Proforma Invoice Number : _____________
the correct units of measure for each entry. For clarification
and/or additional information, do not hesitate to contact Application Control Number : _____________
POD-EMB-DENR.
Document Number : _____________
I. Applicant’s (Juridical) Name: _______________________________________________________________
II. Business Address: _________________________________________ Contact Number: ______________
III. Point Person : __________________________________ Contact Number: ______________
Position / Designation : __________________________________
IV. Type of Importer: (please mark X the appropriate box/boxes and fill-up the fields corresponding to it/them)
Importer - Distributor

Importer - End-user
V. Data on Substance Subject to Importation:
Brand / Trade / Commercial Name: _________________________________________________________
Quantity (in kg): ____________________________ Purchase Price (in $ / kg): _____________________
Intended Use: __________________________________________________________________________
(please mark X the appropriate box and fill-up the fields corresponding to it)
Substance of Single Chemical Composition
Generic Name: _____________________________ Chemical Formula: _____________
Substance of Multiple Chemical Composition Blend Generic Name: ___________

IV. Transaction Data:
Name of Manufacturing Company: __________________________________________________________

Business Address: _________________________________________ Contact Number: ______________
Name of Exporting Company: ______________________________________________________________
Business Address: _________________________________________ Contact Number: ______________
Port of Loading: ______________________ Port Address: ______________________________________
Expected Date of Arrival: _________________________________________________________________
Expected Port of Arrival: _______________ Port Address: ______________________________________
VII. Present Inventory of Same Substance Subject for Importation (under applicant’s custody)
Quantity (in kg): _____________________________ Size of Storage Area (in m2): ___________________
I acknowledge that this application form is a legally binding document, and I declare, under the
penalties of perjury, that the same has been accomplished in good faith, verified by me, and, to the best of my
knowledge and belief, is true and correct pursuant to the regulations issued under authority thereof.
___________________________________
(Authorized Signature over Printed Name)
FORM B
RECORD OF ACTUAL ARRIVAL OF SHIPMENT (RAAS)
Important Note:
This document provides information relevant to the
immediately preceding importation for the same substance Enclosure / Attachment of
applied for and is a vital requirement for processing any
subsequent import application. It must be fully accomplished Application Control Number : _____________
and submitted with the appropriate Bill of Lading.
1. Company Name : ___________________________________________________________________
2. Preceding Pre-Shipment Importation Clearance Information
a. Application Control Number : ____________________________________________________
b. Brand / Trade / Commercial Name : ____________________________________________________
c. Issued Quantity (in kg) : ____________________________________________________
d. Date Issued : ____________________________________________________
e. Expiration Date : ____________________________________________________
3. Actual Arrival of Import
Bill of Lading (please mark X the box if Bill of Lading is attached)
a. Date of Actual Arrival : _______________________Unit Cost / Net Weight (in kg): _______________
b. Actual Arrival Quantity / Net Weight (in kg): _______________________________________
c. Bill of Lading No.: ___________________________ Bill of Lading Quantity: ____________________
d. Invoice No. of : ______________________________ Invoice No. Quantity: _____________________
4. Port of Arrival and Address : ____________________________________________________________
5. Substance Identity
a. Single or Multiple Chemical Composition : _____________________________________________
b. For Single Chemical Composition
Generic Name: ________________________________ Chemical Formula: _____________
c. For Multiple Chemical Composition Blend Generic Name: ______________
Percent: ______ Generic Name: ________________________________ Chemical Formula: _____________
AUTHORIZED SIGNATURE :
____________________________________________________________
NAME : ____________________________________________________________
POSITION : ____________________________________________________________
DATE : ____________________________________________________________
FORM C
SUMMARY OF TRANSACTIONS FOR PREVIOUS INVENTORY AND IMMEDIATELY
PRECEDING IMPORTATION OF THE SAME SUBSTANCE
Important Note:
This document describes how previous inventory and
importation of the same substance applied for were Enclosure / Attachment of
distributed to suppliers and end-users. This is crucial in
cross-checking the previously declared actual transactions. Application Control Number : _____________
All information must be supplied completely. Fill up as many
forms as necessary. All record relevant to the transactions
must be made available to EMB as may be required.
BRAND / TRADE / COMMERCIAL NAME : _______________________________________________________
PRECEDING PRE-SHIPMENT IMPORTATION CLEARANCE
APPLICATION CONTROL NUMBER : ________________________________________________

PREVIOUS INVENTORY QUANTITY (in kg) : ________________________________________________
QUANTITY APPLIED (in kg) : ________________________________________________
ACTUAL ARRIVAL QUANTITY (in kg) : ________________________________________________
TOTAL QUANTITY DISTRIBUTED (in kg) : ________________________________________________

Nature of
Name of Enterpris Intended Use Quantity Official
Contact Date of
Person or Address e (dealer (for end- Distribute Receipt
Number Sale
Company and/or user) d (in kg) Number
end-user)
DATE ACCOMPLISHED : ______________________________________________________________________
SIGNATURE : ______________________________________________________________________
NAME : ______________________________________________________________________
POSITION : ______________________________________________________________________
TOTAL QUANTITY DISTRIBUTED (in kg) : ________________________________________________
Nature of
Name of Enterpris Intended Use Quantity Official
Contact Date of
Person or Address e (dealer (for end- Distribute Receipt
Number Sale
Company and/or user) d (in kg) Number
end-user)
SIGNATURE : ______________________________________________________________________
NAME : ______________________________________________________________________
POSITION : ______________________________________________________________________
FORM D
LIST OF INTENDED USERS FOR THE
PRE-SHIPMENT IMPORTATION CLEARANCE APPLICATION
Important Note:
This document enumerates all persons, natural or juridical,
to whom the substance to be imported will be distributed. Enclosure / Attachment of
The same will be validated by the transaction records to be
appended on the succeeding applications. Application Control Number : _____________
BRAND / TRADE / COMMERCIAL NAME : _______________________________________________________
QUANTITY TO BE IMPORTED (in kg) : __________________________________
TOTAL QUANTITY INTENDED TO BE DISTRIBUTED (in kg) : __________________________________

Nature of
Intended
Name of Enterprise Purchase Order
Contact Intended Use Quantity to be
Person or Address (dealer Number Covered
Number (for end-user) Distributed (in
Company and/or by Transaction
kg)
end-user)
SIGNATURE : ______________________________________________________________________
NAME : ______________________________________________________________________
POSITION : ______________________________________________________________________
B. For Hazardous Wastes and Substances (Title III):
1. Registration of Hazardous Waste Generator
The generator of hazardous waste is required to notify or register with the

Department on the type and quantity of wastes generated and be issued the
corresponding DENR Identification Number. DENR Memorandum Circular No.
2002-12 delegated to the EMB Regional Offices the registration of Hazardous
Waste Generators, including the issuance of "Permit to Transport" provided at
Section 7 hereof.
Requirements:
a. Duly accomplished Hazardous Waste Registration Form A (shown below)

b. Process Flow Diagram of all waste streams
c. Material Balance of manufacturing process
d. Analysis of wastes
e. Photocopy of the Environmental Compliance Certificate (ECC)
f. Photocopy of valid Permit to Operate Pollution Control Facilities
g g. Accomplished Form A4 for the TSD Facility, for on-site treatment
h. Other relevant information e.g. planned changes in production
processes or output
i. Proof of payment of Registration Fee prescribed thereof
Procedural Flow. The processing of application for a Certificate of

Registration or Hazardous Waste Generator's DENR ID Number is
outlined in the following Flowchart: (Figure H-1)
PROCEDURAL FLOWCHART
Registration for Hazardous Wastes Generator’s DENR ID Number
APPLICANT
Not complete
Hazardous Waste Generator’s DENR ID Number Application Form:

1. Accomplished Form A
2. Process Flow Diagram/s of all stream/s
3. Material Balance/s
4. Analysis of Waste/s
5. Other Relevant Information
6. Photocopy of the Environmental Compliance Certficate (ECC)
7. Photocopy of Valid Permits to Operate Pollution Control Facilities
8. If on - site treatment is present, accomplished A4 Form for the TSD Facility
Complete
EMB RECORDS SECTION
1 day
ENVIRONMENTAL QUALITY DIVISION
1 day
HAZARDOUS WASTES MANAGEMENT SECTION
Additional Requirements
10 days - Evaluation and Site Inspection/Inspection
2 days
OFFICE OF THE DIRECTOR
Comments/Inquiries/Revision
5 days
HW DENR ID No.
Steps:
a. Applicant/Generator submits duly accomplished Hazardous Waste Generators

(HWG) Form A together with the requirements identified above.
b. EMB Records Section accepts application, forwards to the Office of the
Regional
Director (ORD) thereby directs Environmental Quality Division (EQD) for the
required processing.
a. EQD – Hazardous Waste Management Section (HWMS)
evaluates/processes
application; conducts site inspection.
b. HWMS prepares report of inspection, recommends approval of registration
and
assigns HWG DENR ID Number
c. ORD approves Registration and issues the corresponding DENR ID Number
to
the applicant /generator
Hazardous Waste Transporter Registration and Permit to Transport
The transport of hazardous waste requires the transporters to be registered with,

and prior permit secured, from the Department or Bureau of which registration of
the transporter and the application for the issuance or amendment of the same
(the permit) shall be made in accordance with the form and in manner prescribed
hereunder:
2.1 Registration of Hazardous Waste Transporter
Requirements:
a. Official Letter of Request

b. Duly accomplished Registration Form C for Hazardous Waste Transporter
(shown below)
c. Business Permit/SEC Registration Certificate
d. Description/Specification of Conveyance. Details of Transport Service
e. Photographs of conveyance (inside and outside shots of vehicle)
f. Sketch/Provision of a garage
g. Proof of ownership of vehicle (Contract of Lease and/or Deed of Sale)
h. Copies of LTO Registration/Insurance of Vehicle
i. Certification from the Bureau of Fire Protection, in case of tank lorry
j. Proof of Transporter’s Experience in Effective Handling of Hazardous Wastes
k. Proof of Transporter’s Readiness/preparedness during emergencies in
case of accident and/or spills (attach Contingency/Emergency
Preparedness Plan)
l. Accountability Statement (duly notarized)
m.Proof of payment of Registration Fee and charges prescribed thereof
Procedural Flow : The procedures to be followed in the registration of

Hazardous Waste Transporter is outlined in the following Flowchart (Figure H-
2):
Registration of Hazardous Waste Transporter
APPLICANT
Not complete
Recognition as Hazardous Wastes Transporter Requirements:

1. General Information of the HW Transporter
2. Official Letter of Request
3. Description/Specification of Conveyance. Details of Transport Service
4. Photograph(s) of Conveyance (inside & outside shots of vehicle)
5. Copies of LTO registration / insurance of vehicle/s
6. Sketch/Provision of a Garage
7. Bureau Of Fire Protection Certification (In Case Of Tank Lorry)
8. Description of Transporter's Experience in Handling Hazardous Wastes
9. Description of Transporter's Trainings (I.e. contingency/emergency planning)
10. Duly Notarized Accountability Statement
Complete
EMB RECORDS SECTION
1 day
1 day
2 days
5 days
HW Transporter
Steps:
a. Transporter submits official letter of request together with duly accomplished

Registration Form C and the complete above-listed requirements.
b. EMB Records Section of the Regional Office accepts and records receipt of
application; forwards to the Office of the Regional Director (ORD) which then
directs the Environmental Quality Division (EQD) for the required
processing.
c. EQD-Hazardous Waste Management Section (HWMS) evaluates/processes
application and the submitted documents; conducts site inspection and
prepares report thereof
d. EQD-HWMS recommends approval and issuance of Registration Certificate.
e. ORD approves Registration, and issues the same to the applicant upon
payment of the required fees and charges prescribed thereof.
2.2 Permit to Transport Hazardous Waste
Requirements:
Official Letter of request from the transporter

Duly accomplished Application Form (shown below)
Prior consent of host Region where treater is located
Annual Registration of transporter
Memorandum of Agreement or Affidavit of Joint Undertaking between
the transporter, generator and treater/recycler/disposal
facility indicating responsibilities and liabilities of each party
Payment of Filing Fee prescribed thereof .
Procedural Flow. A Flowchart for the processing of application for a “Permit

to Transport” hazardous waste is shown below: (Figure H-3)
Application for a “Permit to Transport” Hazardous Wastes
APPLICANT
Permit to Transport Hazardous Wastes Checklist of Information Requirements:

Not complete
1. Official Letter of Request
2. Information on the Registered/Accredited Transporter
3. Information on the Hazardous Wastes Generator
a. DENR ID Number
b. HW Generator’s Quarterly Report
4. Information on the Hazrdous Wastes Generated
a. Type of Waste and Quantity Generated/Annum
b. Type of Waste and Quantity to be Transported
c. Waste Description/Composition (include Official Results of Analyses
d. MSDS
5. Information on the Treater/Recycler/Disposal Facility
a. ECC
b. Valid Permit to Operate (P/O) of the Pollution Control Facilities
c. Detailed Process Flow Diagram/s
d. Detailed Narrative Description of the Process Flow Diagram/s
6. Memorandum of Agreement or Affidavit of Joint Undertaking between the transporter,
generator and treater/recycler/disposal facility indicating responsibilities and liabilities of each
party
Complete
EMB RECORDS SECTION
1 day
1 day
2 days
5 days
Transport Permit
Steps:
a. The Applicant/Transporter submits letter of request

enclosed with duly accomplished Application Form plus the
complete above listed requirements;
b. Records Section of EMB Regional Office documents the receipt of the
request/application; forwards the same to the Office of the Regional
Director/Chief, Environmental Quality Division (EQD);
c. EQD-Hazardous Waste Management Section (HWMS) processes/evaluates
the
application, conducts field inspection and prepares report thereof;
d. EQD recommends approval and issuance of a permit
e. ORD approves the “Permit to Transport”, and issues the same to the
applicant/transporter upon payment of permit fees and charges prescribed
thereof
3. Registration of Hazardous Waste Treatment, Storage and Disposal

(TSD) Facility. The requirements for the registration and issuance of DENR
ID Number for Hazardous Waste TSD Facility/ies are as follows:
Requirements:
a. Duly accomplished Application for Registration, Form B (shown below) ;

b. Copy of Environmental Compliance Certificate (ECC);
c. Copy of Authority to Construct/Permit to Operate for Water Pollution Control
Facilities and/or for Air Pollution Source/Control Device
d. Copy of Environmental Impact Statement (EIS) or Initial environmental
Examination (IEE)
e. Emergency/Contingency Plans including Abandonment Plan
f. Process flow and detailed description of each treatment/recycling/disposal
process technologies including overall material balance identifying all/by-
products, and end-products and residues
g. Pollution Control Officer accreditation certificate
h. Storage Management Plan for raw materials, residues, by products and end-
products
i. Long-term plan for the recycled/processed/end-product
j. Photographs of the facilities showing processing areas, storage areas
k. Accountability statement, duly notarized
l. Proof of payment of filing fees prescribed thereof
Procedural Flow. The processing of application for Registration and

issuance of corresponding TSD Facility DENR ID Number is shown in the
following Flowchart: (Figure H-4)
Registration for Hazardous Wastes Treatment, Storage and Disposal Facility DENR
ID Number
APPLICANT
Not
complete
Hazardous Waste TSD Facility DENR ID Number Application Form :

1. Accomplish form for registration
2. Environmental Compliance Certificate
3. Authority to Construct (A/C) Wastewater Treatment Facility (WTF)
and Air Pollution Control Device (APCD) (if applicable) Issued by
the EMB Regional Office
4. Copy of Environmental Impact Statement or Initial Environmental
Examination and
5. Emergency/Contingency Plans including Abandonment Plan
Process flow for all treatment/recycling/disposal technologies
including overall material balance
Complete
EMB RECORDS SECTION
1 day
1 day
10 days – Evaluation and Site Inspection/Inspection
2 days
5 days
HW DENR ID NO.
-------------------------
-------------------------
-------------------------
-------------------------
Steps: -------------------------
a. The treater submits duly accomplished Registration Form together with the
complete above-cited requirements;
b. The Records Section of the EMB Regional Office documents the receipt of
application and forwards to the Office of the Regional Director (ORD)/Chief
Environmental Quality Division (EQD) for instruction/ appropriate action
c. EQD-Hazardous Waste Management section (HWMS) processes/evaluates
application; conducts site inspection and prepares report thereof;
d. EQD recommends approval of registration with the corresponding TSD
Facility DENR ID Number
e. ORD approves registration, and issues the same to the applicant/treater upon
payment of registration fees and charges prescribed thereof.
4. Importer Registration and Clearance for Importation of Recyclable

Materials Containing Hazardous Substances
Requirements:
a. Official Letter of Request;

b. Duly accomplished application for Registration of HW Importer Form D,
Importer Registry Sheet, and Importation Clearance for Recyclable Materials
Form (all these forms are shown below);
c. Environmental compliance Certificate (ECC);
d. "Permits to Operate"
- Air Pollution Source/Control Facility
- Wastewater Treatment Facilities
e. Notification from the Country of Export;
f. Registration/Accreditation as Recycler, DENR ID No.;
g. Copy of Insurance Coverage for the shipment;
h. Purchase Order;
i. Last Bill of Lading;
j. Affidavit of Joint Undertaking of Exporter/Importer specifying the following:
- liabilities for clean up operations in case of spill and emergencies
- responsibility of the exporter to retrieve/return the waste when denied
entry by the Government of the Philippines
- liabilities of parties to compensate for damage to properties and life
in case of emergencies and accidents;
k. Proof of payment of application fees for Importation registration and
clearance.
Procedural Flow. Following below is the Flowchart for Hazardous Waste

Importation Registration and Clearance. (Figure H-5)
.
EMB Complex, DENR Compound, Visayas Ave., Diliman, Quezon City
Procedural Flowchart
Hazardous Waste Importation Clearance
APPLICANT EMB
Checklist
Visit EMB WEBSITE Get requirements for Provide Checklist of
www.emb.gov.ph to download Import Clearance Requirements for
Hazardous Waste Registration form Application Importation Clearance
Register NO Provide Application form Process

ed For Importer’s Registry
with Application Form
EMB?
YES Fill-up and submit

Registry form to
EMB Need NO
Process Application Inspectio
Form n?
YES
Issue Importer’s Registry Inspection of Recycling

Certificate
Facility
Complete Required Documents

for Importation Clearance and submit
Issue Importation
to EMB 60 days before importation
IMPORT Clearance
CLEARANCE Importation
Clearance
Cc: Bureau of Custom
Prepared by:
Environmental Quality Division - Hazardous Waste Management
Section
Environmental Management Bureau
Steps:
a. The Importer submits Official Letter of Request together with, if still not yet
registered as importer, duly accomplished Hazardous Waste Registration Form
D and Importer Registry Sheet), enclosed with the above-listed other
requirements.
b. If already registered, at least sixty (60) days prior to importation, the applicant
submits the Importation Clearance for Recyclable Materials Form together with
Importer’s Registry Certificate issued by the EMB
c. Records Section of the EMB Central Office documents the receipt of the
application for Registration/Importation Clearance, forwards the same to the
Office of the Director (OD), EMB.
d. OD directs EQD/Hazardous Waste Management Section (HWMS) to process
aforecited application
e. EQD/HWMS evaluates application and conducts inspection of Recycling
Facility; prepares report and recommendations for the approval of Registry
Certificate/Importation Clearance.
f. EMB Director approves Registry/Importation Clearance, and issues the same to
the applicant/Importer upon payment of the required fees and charges
prescribed thereof
5. Export Clearance-Transmittal Notification for Hazardous Waste/Recyclable

Materials
Requirements :
a. Official Letter of Request addressed to the EMB Director

b. Duly accomplished Notification Form, copy shown below, if seeking Transmittal
Notification
c. Notification/Consent of Importing Country and or Transit Country if applicable
d. Hazardous Waste Registration of the Generator(s)
- DENR ID Number
- Latest Quarterly Report
e. Insurance Certificate of Cover for the shipment
f. Purchase Order
h g. Last Bill of Lading, for renewals
i h. Movement Document/Manifest Form for previous export (If
j applicable)
k i Affidavit of Joint Undertaking of Exporter/Importer specifying the following:
- liabilities for clean up operations in case of spill and emergencies
- responsibility of the exporter to retrieve/return the waste when denied
entry by the Country of Export
- liabilities of parties to compensate for damage to properties and life in
case of emergencies and accidents;
b. Proof of payment of the filing /clearance fee prescribed thereof.
Procedural Flow. Following are the flowcharts (Figures H-6a and H-6b) of the
processes involved in securing Export Clearance and Transmittal Notification for
Hazardous Wastes/Recyclable Materials
Application for Export Clearance - Transmittal of Notification
APPLICANT
Not complete
Exportation Clearance & Permit to Transport Hazardous Wastes/
Recyclable Materials
1. General Information of the Exporter 9. Movement Document/
2. Official Letter of Request Manifest of Previous Export
3. Accomplished Notification Form 10. Affidavit of Joint Undertaking
4. HW Generator’s DENR ID Number of Exporter and Importer
5. HW Generator’s Latest Quarterly Report
6. Insurance (Shipment)
7. Purchase Order
8. Last Bill of Lading, for renewals
Complete
EMB RECORDS SECTION
1 day
1 day
2 days
5 days
Exporter’s
Notification Transit Country
Country of Destination
Application for Export Clearance
TRANSIT COUNTRY COUNTRY OF DESTINATION
OFFICIAL CONSENT OFFICIAL CONSENT
EMB RECORD SECTION
1 day
1 day
10 days
2 days
5 days
Export Clearance
Steps:
a The Exporter submits official letter of request for Transmittal Notification to the
EMB Director with the complete above-listed requirements and payment of
corresponding fee.
b. EMB Records Section documents the receipt of the request from the exporter;
forwards the same to the Office of the Director (OD) which then directs the
Environmental Quality Division (EQD) for appropriate action.
c. EQD/Hazardous Waste Management Section (HWMS) processes/evaluates
request/application, conducts site inspection, and recommends issuance of
Transmittal Notification Certificate and/or Export Clearance, whichever is
applicable.
d. EMB Director/OD approves Exporters Notification and/or Export Clearance,
and issues the same to the applicant.
Required Forms
The prescribed forms required to be duly accomplished for registration and

clearance applications for Hazardous Wastes and Recyclable Materials containing
Hazardous Substances are shown in the following pages.
Form A : Registration form for HW Generator
Section A1. General Information of Generator
1. DENR *1 2. Date of issued / / *1
ID: (D/M/Y):
3. Name of Firm:
4. Plant Address:
5. Date of
Establishment:
6. Tel: 7. Fax:
8. Office Address:
9. Tel: 10. Fax:
10. Pollution Control
Officer:
11. Tel: 12. 13. e-
Fax: mail:
14. General Description of
Business/Operation
Philippine Standard Industrial Classifications 15. 16.
Primary: Secondary:
16. Major 1. 4.
Products: 2. 5.
3. 6.
17. Authorized Capitalization (Pesos/year)
18. Paid-up Capitalization (Pesos/year)
19. Approximate Annual Turn-over
(Pesos/year)
20. Total No. of Employees: 21. Admi. Employees: 22. Plant Employees:
Please append the following:

(1) Process flow diagram all waste streams
(2) Mass balance of manufacturing process
(3) Description of existing waste management plan
(4) Analysis of waste(s)
(5) Other relevant information e.g. planned changes in production processes or output,
comparison with related operations.
(6) Copy of Environmental Compliance Certificate (ECC)
(7) Copy of Valid Permits to Operate Pollution Control Facilities
(8) If on-site treatment is present, submit the A4 form for every TSD facility.
I certify that the enclosed information is a true and accurate record as available.
Pollution Control Officer:
Signature: Date (D/M/Y): / /

*1: to be filled up by EMB
Section A2. Waste Generation Per Year by Type of Waste (Approximately)
HW Cataloging 8. Total Volume
1. HW No. 2. Waste name & description 3. HW Nature
4. Toxic 5. Corrosive 6. Reactive 7. Flammable (ton/year)
HW Nature: Lq = Liquid, So = Solid, Sl = Sludge, Ga = Gases

HW Nature: Write “Yes” or “No” under each column (Toxic, Corrosive, Reactive, Flammable)
Section A3. Waste Storage, Transport, Treatment and Disposal
2. TSD 3. Volume 4. Storage Transporter Treater Disposal
1. HW No. *1
Location (ton/year) Method*2 5. ID No. 6. Name 7. ID No. 8. Name 9. Method 10. ID No. 11. Name 12. Method
*1 TSD Location: On-site or Off-site
*2 Storage Method: Drum, Carboy, Sack, etc.
*3 Treatment Method A=Physico-Chemical B=Thermal C=Solidification D=Storage E=Disposal F=Recycle
A4. Information of HW Treatment Premises
1. DENR ID: 2. Date of issued (D/M/Y): / /
3. Name of Firm:
4. Address of
TSD:
5. Treatment method and Capacity:

A: Physico-Chemical treatment
B: Thermal treatment
C: Solidification
D: Storage
E: Disposal
F: Recycle
Method Date of permit to Treatment Capacity Type of HW can be treated
operate (ton/day)
/ /
/ /
/ /
/ /
/ /
(1) Copy of Environmental Compliance Certificate (ECC)
(2) Copy of Valid Permit to Operate pollution control facilities
(3) Initial Environmental Examination (IEE) or Environmental Impact Statement (EIS) submitted
to the EMB Regional offices
(4) Process flow Diagram and detailed description of each treatment/recycling process identifying
all/by-products, end-products and residues
(5) Pollution control officer accreditation certificate
(6) Storage management plan for raw materials, residues, by-products and end-products
(7) Photograph/s of the facilities showing processing areas, storage areas
Form C : Registration form for HW Transporter
Section C1. General Information of Transporter
3. Registered Company Name:
4. Address:
5. Date of Establishment:
6. Tel: 7. Fax:
8. Name of contact person:
9. Tel: 10. Fax: 11. e-mail:
12. General Description
of Business/Operation
13. Authorized Capitalization (P/year):
14. Paid-up Capitalization (P/year):
15. Total Employees: 16. Admin. Employees: 17. Number of Drivers

 (1) Business permit approved by Department of Trade and Industry (DTI) and Securities
and Exchange Commission (SEC) registration
 (2) Photograph of vehicle shooting front/back view and side view
 (3) Provision for a garage include sketch map
 (4) Proof of ownership of vehicle
 (5) LTO registration
 (6) Contract/s of Lease and/or Deed/s of Sale of the vehicle/s, (if applicable)
 (7) In case of tank lorry, attach Bureau of Fire protection certification
 (8) Description of contingency and emergency plan in case of accident/s and/or spillages
 (9) Accountability statement (Duly notarized)
I certify that enclosed information is a true and accurate record as available.
Contact Person:
Signature: Date(D/M/Y) / /
Section C2. Transport Capacity
Description of vehicle for HW transportation No. of vehicles:
4. Capacity
1. Plate No. 2. Maker 3. Year 4. Type *1 Own/Lease
(ton)
Contact Person:
*1 Type of vehicles: FB=Flat Body, CFB=Closed type of FB, TL=Tank lorry, DT= Dump
truck
APPLICATION FORM FOR TRANSPORT PERMIT
Name of Applicant :
Plant Address: Tel. No
Type of Waste : Class No. :
Quantity of Waste :
Brief description of waste applied for transport :
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________________________
Generator : ID NO.
Transporter : ID NO.
Treater : ID NO.
ATTACHMENTS :
1. Prior Consent of Host Region where treater is located

2, Annual Registration of Transporter
___________________________________
Applicant’s Signature
Form B : Registration form for HW Treater
B1: General Information of Treater
3.Registered Company Name:
4. Address of head office:
5. Name of the President
6. Tel: 7. Fax:
8. Address of the Plant:
9. Tel: 10. Fax:
11. Pollution Control Officer:
12. Tel: 13. Fax: 14. e-mail:
15. Date of Establishment (D/M/Y): / /
16: Authorized Capitalization (P/year):
17: Paid-up Capitalization (P/year):
18. Total Employees: 19. Admin. Employees: 20. Plant Employees:
21. Treatment method and Capacity:

A: Physico-Chemical treatment
B: Thermal treatment
C: Solidification
D: Storage
E: Disposal
F: Recycle
Treatment Date of permit to Treatment Capacity Type of HW can be treated
Method Operate (ton/day)
/ /
/ /
/ /
/ /
/ /
Please append the following for each TSD premises:
 (1) Copy of Environmental Compliance Certificate (ECC)
 (2) Copy of Valid Permit to Operate pollution control facilities
 (3) Initial Environmental Examination (IEE) or Environmental Impact Statement (EIS)
submitted to the EMB Regional offices
 (4) Process flow Diagram and detailed description of each treatment/recycling process
identifying all/by-products, end-products and residues
 (5) Pollution control officer accreditation certificate
 (6) Storage management plan for raw materials, residues, by-products and end-products
 (7) Long term plan for the recycled/processed/end-product
 (8) Photograph/s of the facilities showing processing areas, storage areas
 (9) Accountability statement (Duly notarized)
President:
Form D : Registration form for HW Importer / Exporter

D. General Information of HW Importer / Exporter
1. DENR ID: 2. Date of issued / /
(D/M/Y):
3. Registered Company
Name:
4. Address:
5. Date of Establishment:
6. Tel: 7. Fax:
8. Name of Contact Person:
9. Tel.: 10. Fax: 11. e-
mail:
12. General Description
of Business/Operation
13. Authorized Capitalization (P/year):
14. Paid-up Capitalization (P/year):
15. Total Employees:
Representative person:
Department of Environment and Natural Resources Form No. ______________
Environmental Management Bureau Sheet No. ______________
IMPORTER REGISTRY SHEET (to be filled out in triplicate)
Please read instruction before filling up this application.
A. IMPORTER INFORMATION
Name of Importer _________________________________________________________________
Address_________________________________________________________________________
Contact Person___________________________________________________________________
Telephone No. _______________________ Fax No.:_____________________________________

Reason for Import:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
B. WASTE GENERATOR/SHIPPER INFORMATION

Generator/Shipper Name: __________________________________________________________
Facility Address (site of recyclable material generation):___________________________________
Generator Company Name: CITY, STATE/PROVINCE, COUNTRY _________________________
Technical Contact: ________________________________________________________________
Phone No.: __________________________________ Fax No.:____________________________
C. RECYCLING FACILITY INFORMATION

Name of Company:________________________________________________________________
Address:________________________________________________________________________
Telephone No.:_______________________________ Fax No.:_____________________________
Contact Person:__________________________________________________________________
Method of Processing:_____________________________________________________________
Description Process:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
 Methods for handling, including collection, packaging, labelling, transportation, and route
which must conform with internationally accepted standards;
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
 Listing of personnel who will be responsible for supervising the collection, transport and
unpacking of the recyclable materials and their respective qualifications; and
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
 Emergency response plan describing steps to be taken by parties concerned in case of

spill/accident which may occur during transport from the premises of the recyclable material
generator to the importer.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(Please use separate sheet if necessary)
Attach all Environmental Permits of Recycling Facility
D. RECYCLABLE MATERIAL INFORMATION (See instructions)

Recyclable Materials/s Name _______________________________________________________
Original Form of the Recyclable Material:______________________________________________
Amount/Units to be imported for the whole year:_________________________________________
Frequency of the importation: Weekly Quarterly Other, specify ___________
Monthly Semi-Annually
E. TRANSPORTATION INFORMATION
Type of Packaging : Bulk Liquid Bulk Sludge Bulk Solid
Drum/Box Tanked Others,Specify _____________
Mode of Shipment Air Sea
This form is to be completed per recyclable material to be registered. Instructions for completing
this form are attached
F. PHYSICAL CHARACTERISTIC OF RECYCLABLE MATERIAL (See Instructions)
Color 2. Does the recyclable 3.Physical State@ 4. Layers 5. Density 6. Free Liquids
materials have a strong 700F/21OC:
incidental odor? __ Solid __Semi Solid __Multi layered Range : ___Yes ____ No
__Liquid __ Powder __Bi-Layered
No Yes, if so other:________________ __Single Phased _________________ Volume:_________%
Describe:____________
pH <2 <2-4 4-7 7 7-10 10 <12.5 12.5 Range NA
Flash Point None < 1400 /600 140 1990F/60-930C >2000F/930C Closed Cup Open Cup
CHEMICAL COMPOSITION RANGE 2. Does the waste contain any of the following
(MIN-MAX) (provide concentration if known):
________________________ ________% NO or LESS THAN or ACTUAL

________________________ ________% PCBs 50 ppm _____ppm
________________________ ________% Cyanides 50 ppm _____ppm
________________________ ________% Sulfides 50 ppm _____ppm
________________________ ________% Phenols 50 ppm _____ppm
* If applicable, a certified laboratory analysis from the country of origin should be attached
IMPORTER CERTIFICATION
By signing this profile sheet, the importer verifies:
1. This recyclable material is not “Hazardous Waste” as defined by GOPs RA6969 and/or
international regulations.
2. This recyclable material does not contain regulated radioactive materials or PCBs
(Polychlorinated Biphenyls).
3. The recyclable material does not contain regulated concentration of banned and controlled
pesticides.
4. This recyclable material does not contain halogenated compounds such as: tetrachloroethylene,
trichloroethane, methylethylene chloride, 1,1,1-trichloroethane, trichlorofluoromethane 1, 1
dichloroethylene, and 1, 2-dicloroethylene at greater than 0.1% (1,000 ppm) total solvent
concentration.
5. This sheet and the attachments contain true and accurate descriptions of the recyclable
materials. All relevant information regarding known or suspected hazards in the possession of
the Generator have been disclosed.
6. The Importer has read and understand the form. All types and amounts of hazardous
substances provided in incidental amounts have been identified in Section G of this form.
7. The analytical data presented herein or attached hereto were derived from testing a
representative sample taken in accordance with RA6969, if required, or equivalent rules.
8. If any changes occur in the character of the recyclable material, the Importer shall notify the
Environmental Management Bureau prior to the shipping of the recyclable material to the
consignee/recycler.
9. Signature:_______________________________ 10. Title:_________________________
11. Name (type or Print) ______________________ 12. Date_________________________
Do not write below this line
-----------------------------------------------------------------------------------------------------------------------------------------
REGISTRY REFERENCE CODE

Date:
Accept
Reject
AUTHORIZED NAME: (Print or Type)
AUTHORIZED SIGNATURE: Place EMB seal here
TITLE
Department of Environment and Natural Resources Form No. ____________
Environmental Management Bureau Sheet No.____________
IMPORTATION CLEARANCE FOR RECYCLABLE MATERIALS to be filled out in triplicate
A. IMPORTER INFORMATION :
1. Name of Importer _____________________________________________________________
2. Registry Reference Code _______________________________________________________
3. Address _____________________________________________________________________
4. Contact Person _______________________________________________________________
5. Telephone No. ___________________ Fax No. ___________________________________
B. WASTE GENERATOR/SHIPPER INFORMATION

1. Generator (Shipper Name) ______________________________________________________
2. Facility Address _______________________________________________________________
C. RECYCLING FACILITY INFORMATION:

1. Name _______________________________________________________________________
2. Address _____________________________________________________________________
D. RECYCLABLE MATERIAL INFORMATION :

1. Type of Material _______________________________________________________________
2. Volume of Material Imported _____________________________________________________
3. Type of Packaging_____________________________________________________________
4. Intended Carriers ______________________________________________________________
5. Mode of Shipment AIR SEA
6. Port of Entry __________________________________________________________________
7. Expected Date of Arrival ________________________________________________________
E. ATTACHMENTS:
To be attached to this IC are the following affidavits of undertaking specifying the following:
1) Liabilities for clean up operations in case of spill and emergencies;

2) Responsibility of the exporter to retrieve/return the waste when denied entry by the Government of
the Philippines;
3) Copy of insurance coverage for the shipment; and
4) Liabilities of parties to compensate for damage to properties and life in case of emergencies and
accidents.
F. Signature __________________________________ Title _______________________________

Name (Type or Print)_________________________ Date_______________________________
--------Do not write below this line---------

(to be filled up by EMB)
DISAPPROVED
APPROVED: Pursuant to DAO ____which hereby grants you clearance to import only the above cited
material subject to the conditions stated hereunder:
___________________________ ____________________________________
Date Director, Environmental Management Bureau
TRANSBOUNDARY MOVEMENT OF WASTE - Notification
BASEL CONVENTION
Notification
N
1. Exporter (name, address): 3. Notification concerning (1)
A (I) Single movement (I) Disposal (no recovery)
(II) General notification (multiple movements (II) Recovery operation
Contact person: Tel.:
Fax/Telex: C. Pre-authorized for a recover facility (1) Yes
No
Reason for export : (To be completed for a recovery facility located in an OECD State)
2. Importer (name , address): 4. Total intended number 5. Estimated quantity (3)
of shipments : ________________ kg
________________ liters
Contact person: Tel.: 6. Intended date(s) or period for shipment(s):

Fax/Telex:
7. Intended carrier(s) (name, address) (2): 8. Disposer (name, address(s):
Contact person: Tel.: Contact person: Tel.

Fax/Telex: Fax/Telex:
Actual site of disposal :

10. Waste generator (name, address) (2): 9. Method(s) of disposal:
D code/ R code (4)

Technology employed:
Contact person: Tel. (Attach details if necessary)
Fax/Telex: 11. Means of transport (4): 12. Packaging type(s) (4):
Site generation & process:
13. (1) Designation & chemical composition of the waste: (ll) Special handling requirements 14. Physical characteristic (4):
17. Y number (4):

15 Waste identification code
in country of export : IWIC : 18. N number (4):

in country import : EWC :
Customs code: Other (specify) :
16. OECD Classification (1): 19. (I) UN identification No.: (ll) UN class (4):
amber red acid number: UN Shipping name:
other
(attach details)
20. Concerned states, code number of competent authorities, and specific points of entry and exit:
State of export States of transit State of import
21. Customs offices to entry and/or departure 23. Exporter’s/Generator’s declaration:

(European Community) I certify that the information is complete and correct to my best knowledge. I
Entry: also certify that legally enforceable written contractual obligations have been
entered into and that any applicable insurance or other financial guarantees
are or shall be in force covering the transboundary movement.
Departure
Name : Signature
22. Number of annexes Date
attached:
FOR USE BY COMPETENT AUTHORITIES
24. To be completed by competent authority - Import (ECC,OECD) 25. Consent to the movement provided by the competent
Notification received on: - transit (Basel) authority of (country)
Acknowledgement sent on: Consent given on:

Specific conditions (1) Yes, see block 26over leaf/annex
no
Name of competent authority:
Stamp and/or signature: Name of competent authority:
Stamp and/or signature:
(1) Enter X in appropriate box (2) Attach list if more than one (3) Attach detailed list if multiple shipment (4) See codes on the reverse
List of abbreviations used in the application

DISPOSAL (NO RECOVERY) (Block 9) RECOVERY OPERATIONS (Block 9)
01 Deposit or unto land (e.g. landfill, etc.) R1 Use as fuel (other than in direct incineration) or other
02 Land treatment (e.g. biodegradation of liquid or sludgy discards in soils, etc.) means to generate energy
03 Deep injection (e.g. injection of pumpable discards into wells, salt domes or naturally occurring R2 Solvent reclamation/regeneration
repositories, etc.) R3 Recycling/reclamation of organic substances which are
04 Surface impoundment (e.g. placement of liquid or sludge discards into pits, ponds of lagoons, etc.) not used as solvents
05 Specially engineered landfill (e.g. placement into lined discrete cells which are capped and isolated from R4 Recycling/reclamation of metals and metal compounds
one another and the environment, etc. R5 Recycling/reclamation of other inorganic materials
06 Release into a water body except seas/oceans R6 Regeneration of acids or bases
07 Release into seas/oceans including sea bed insertion R7 Recovery of components used for pollution abatement
08 Biological treatment not specified elsewhere in this list which results in final compounds and mixtures which R8 Recovery of components from catalysts
are discarded by means of any of the operations numbered 01 to 012 R9 Used oil refining or other reuses of previously used oil
09 Physico chemical treatment not specified elsewhere in this list which results in final compounds or mixtures R10 Land treatment resulting in benefit to agriculture or
which are discarded by means of any of the operations numbered 01 to 012 (e.g. evaporation, drying, ecological improvement
calciration, etc.) R11 Used of residual materials obtained from any of the
010 Incineration on land operations numbered R1 to R10
011 Incineration at sea R12 Exchanges of wastes for submission to any of the
012 Permanents storage (e.g. emplacement of containers in a mine, etc.) operations numbered R1 to R11
013 Blending or mixing prior to submission to any of the operations numbered 01 to 012 R13 Accumulation of material intended for any operation
014 Repackaging prior to a submission to any of the operations numbered 01 to 012 numbered R1 to R12
015 Storage pending any of the operations numbered 01 to 012
11 NUMBER (Block 18) AND UN CLASS (Block 19)

MEANS OF TRANSPORT (Block 11) PACKAGING TYPES
UN Class II Number Designation
R - Road 1. Drum
2. Wooden barrel 1 111 Explosive
1 - Train/Rail 3. Jerrican 3 113 Inflammable liquids
4. Box 41 114 1 Inflammable solids
S - Sea 5. Bag 42 114 2 Substances or wastes liable
6. Composite packaging to spontaneous combustion
A - Air 7. Pressure receptacle 43 114 3 Substances or wastes
8. Bulk which in contact with water
W - Inland Waterways 9. Other (specify) emit inflammable gasses

51 115 1 Oxidizing
52 115 2 Organic Peroxides
61 116 1 Poisonous (acute)
61 116 2 Infectious substances
8 118 Corrosives
9 1110 Liberation of toxic gases in
PHYSICAL CHARACTERISTICS (Block 14)
contact with air or water
9 1111 Toxic (delayed or chronic)
1. Powdery / powder 5. Liquid
9 1112 Ecoloric
2. Solid 6. Gaseous
9 1113 Capable by means after
3. Viscous / paste 7. Other (specify)
disposal, of yielding another
4. Sludgy
material e.g. leachate,
which possesses any of the
characteristics listed above
Y numbers (block 17) refer to categories of waste listed in Annex I and II of the Dasel Convention. These codes, as well as more detailed information can be found in an Instruction Manual available
from the Secretariat of the Dasel Convention.
26. SPECIFIC CONDITIONS OF CONSENTING TO THE MOVEMENT

Movement Document
Notification for waste shipment was issued:
Date of issuance: __/__/__
Notification for a single shipment
Notification for a multiple shipments for the period ______
This shipment is nb.________of total shipments included in the general

notification: ________________
1. EXPORTER (NOTIFIER) (1)
Name: Telephone:
Address : Telefax:
Contact Person (name, address, telephone, telefax) :
2. GENERATOR(s) of WASTE
Name: Telephone:
Address : Telefax:
Contact Person (name, address, telephone, telefax) :
Process by which the waste was generated :
Site of generation :
3. DISPOSER OF THE WASTE

Name : TO BE COMPLETED BY THE DISPOSER
Address :
Telephone : Telefax:
Contact Person in case of emergency Certification of receipt of waste at
(name,address,telephone,telefax): Designated disposal facility
Approximate date of Disposal : Method of disposal (3)
D code R code
Actual Site of Disposal : Date : __/__/__
Signature :
Actual date of disposal : __/__/__
Signature of disposer:
4. WASTE
Description of the waste :
Y number H number UN class UN number UN Shipping name IWIC

Code
Physical state at 20o C

powder solid paste/viscous sludge liquid
Gaseous other _______
Estimated quantity per shipment : 1st 2nd 3rd 4th 5th

(kg or L)
Type of Packaging
Number of packages
Special handling requirements, including emergency provisions in case of

accidents:
5. ITINERARY
Country of export :
Point of exit (when designated)
Transit countries:
1) Point of entry (when designated ) :
Point of exit (when designated) :



Country of import:
Point of entry (when designated) :
6. CARRIER OF THE WASTE or his agent
1. Name : Date of transboundary movement

Address : started: __/__/__
Telephone : Telefax :
Contact Person (name, address, tels., telefax): Signature of the carrier(s) or agent :
Means of transportation:
License (when applicable) :
Sea air inland waters
Road rail

Contact Person (name, address, tels., telefax); Signature of the carrier(s) or agent :
Sea air inland waters
Road rail

Contact Person (name, address, tels., telefax); Signature of the carrier(s) or agent :
sea air inland waters
road rail
CONSENT OF THE COMPETENT LOCAL TO BE COMPLETED BY THE GENERATOR OR

AUTHORITY EXPORTER
Declaration that the information is correct:
Declaration indicating no objection from the

competent authorities of all States concerned which
are Parties to the BC:
Date of consent of Exporting

State : __/__/__
Date of consent of Importing

State : __/__/__
Date of consent of Transit
State : __/__/__
Annex to the Notification and Movement Document
1. The Notifier is:
- the person who wants to import hazardous waste within ______; or

- the person who wants to export hazardous waste within ______; or
- the person who wants to transit hazardous waste through _____.
2. “Designation of the waste” means a designation of the nature and the concentration
of the most hazardous components in terms of toxicity and other dangers presented by
the waste both in handling and in relation to the proposed disposal method
3. As per Annex IV of the Basel Convention : D or R code
4. This must include the point of entry and the point of exit of the waste, inside or
outside the country.
5. In the case of a general notification covering several shipments, the expected dates of
each shipment have to be specified. If this is not known, the expected frequency of the
shipments.
…………………………………..

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PMPIN ABBREVIATED FORM

Section A: Premise Information CBI ( )

2. Premise Physical Location and Telephone Number

3. Name of the Responsible Authority

4. Mailing Address and Telephone/Fax Number

5. Circle: Manufacture Import

Section B: Chemical Identification Information CBI ( )

CAS Registry Name IUPAC Common Name

7. CAS Number (if available)

8. RTECS Number (if available)

10. Synonyms for the New Chemical

11. Trade Name of the New Chemical

Section C: Production, Import and Intended Use CBI ( )

12. Total quantity produced or imported in the first 12 months (Kg)

Site Limited Industrial Commercial Consumer

Section D: Regulatory Status in Other Countries

14. Country Name:

15. Regulatory Status of the New Chemical in that country:

(Use a separate page if there are more than one country)

Section E: Statement on Physicochemical Characteristics (if available)

Boiling Point Vapor Pressure

Section F: Statement on Toxicological Effects of the Chemical

(Refer to instruction for the type of test results required)

Section G: Statement on Environmental Effects of the Chemical

Section I: List of Attachments

Name: Position: Date:

Confidential Business Information (CBI)

PMPIN DETAILED FORM

Section A: Premise Information CBI ( )

15. Name of the Responsible Authority

16. Mailing Address and Telephone/Fax Number

17. Circle: Manufacture Import

Section B: Chemical Identification Information CBI ( )

CAS Registry Name IUPAC Common

19. CAS Number (if available)

20. RTECS Number (if available)

21. Molecular Formula

22. Synonyms for the New Chemical

23. Trade Name of the New Chemical

Section C: Production, Import and Intended Use CBI ( )

24. Total quantity produced or imported in the first 12 months (Kg)

Site Limited Industrial Commercial

Section D: Occupational Exposure

Section E: Estimate Environmental Release and Disposal of the New Chemical

14. Country Name:

15. Regulatory Status of the New Chemical in that country:

Yes (attach MSDS) No

(Use a separate page if there are more than one country)

Section G: Physiochemical Test Results

17. Tests Conducted by (Name and Address of the Laboratory):

18. Test Results Attached Yes No

(Refer to instruction for the type of test results required)

Section H: Toxicological Effects Test Results

19. Tests Conducted by (Name and Address of the Laboratory)

20. Test Results Attached Yes No

(Refer to instruction for the type of test results required)

Section I: Environmental Effects Test Results

21. Tests Conducted by (Name and Address of the Laboratory)

22. Test Results Attached Yes No

(Refer to instruction for the type of test results required)

Section K: List of Attachments

Name: Position: Date:

SIGNATURE _ DATE____

____ _

_____ _

ECC No. _

_ ___ _

Address of Storage Facility: ____________________ Contact Number:

Generic Name: _________________ Chemical Formula: _

Percent: Generic Name: ___________ Chemical Formula: _

_ ___ _

Address of Storage Facility: ____________________ Contact Number:

Quantity (in kg): ________ Purchase Price (in $ / kg): _

Generic Name: _________________ Chemical Formula: _

Percent: Generic Name: ___________ Chemical Formula: _