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GAP – F01

Republic of the Philippines

Department of Agriculture
Bureau of Plant Industry

Plant Product Safety Services Division

(02) 524 – 0779;


Fill in all applicable spaces.

1 Applicant’s Name

Name of owner or authorized representative of farm or company

2 Farm Name/Company Name

Indicate the name reflected to the Security and Exchange Commission (SEC) and/or Department of Trade and Industry (DTI) Business Permit.
If cooperative, indicate the name as provided for in the registration with the Cooperative Development Authority (CDA).
3 Correspondence Address
Specify the exact address where correspondence regarding the certification will be sent to.
Street and No.: P.O. Box:
Subdivision: Province :
City: Postal Code:
Phone: Fax: Email:
4 Address and Farm size
For farm applicants with multiple production site, indicate the address (specify the barangay and town)
and size for each site (use additional sheet if necessary).
Address for Farm 1 :
Size of Farm 1 :
Address for Farm 2 :
Size of Farm 2 :
Address for Farm 3 :
Size of Farm 3:
5 Types of Crops Grown
Only crops grown and made for sale should be indicated. Approximate quantity harvested per year must be expressed in amount of produced per
unit of the area planted (use additional sheet if necessary).

Crop Type (variety) Number of Approximate quantity Indicate the Intended

fields/hectares harvested/year Use
(If for food, feed or others,
please specify)

Effective Date: August 1, 2018/Revision No. : 0 Page 1 of 2

6 Supporting Documents (check only document submitted attached with this form)

Farm or organizational profile;

Farm map;
Farm Layout
Field operation procedures
Annex A -Production and Harvesting Records (GAP – F01A)
Annex B - List of fertilizers, pesticides and other agricultural chemicals used (GAP – F01B)
Certificate of Nutrient Soil Analysis
Certificate of training on GAP conducted by ATI, BPI, LGU, DA RFO, SUCs or by ATI
accredited service providers
Certificate of Registration and other related permits, e.g. SEC, DTI, CDA, DOLE (if

For Group Application

For Corporation, Quality Management System or Internal Control System (ICS)

Procedure for accreditation of farmers/growers(if applicable)
Manual of Procedure for outgrowership scheme (if applicable) which will show that the
company/PMOs/cooperative have 100% control of all registered or accredited growers (e.g.
internal policies on accreditation of farmer/grower, sanctions, etc.)

The farm management is committed to good farming practices and to the safety of its
produce for supply to consumers, and in maintaining a high standard of quality in its
production. All measures were taken to fully implement the farm in Philippine Good
Agricultural Practices (PhilGAP) program. I hereby support to adopting and implementing the
PhilGAP standards.

I hereby consent to all the requirements as needed by the inspection body. All
information shall remain confidential at all times, unless prohibited by law. The information
above and those that are seen in the succeeding attachments are hereby certified true and

Signature above printed name : __________________________________

Date : __________________________________

Company Stamp (if Any) :

Effective Date: August 1, 2018/Revision No. : 0 Page 2 of 2