SURIGAO DEL SUR PROVINCIAL OFFICE

CONSUMER WELFARE DESK APPLICATION FORM

Business Details
Name of Business Establishment :
Complete Address :
Type of Business :
Contact No. :
Business Hours :
Membership to Association :

Name of Owner / Manager:

Contact Person Details

Name :
Position / Designation :
Educational Attainment : High School College

Employment Status : Permanent / Regular Contractual

Residence Address :
Telephone No. :
Signature :

I/We hereby certify that all information ecalred hereto ae true and correct to the
best ofmy knowledge and any misdeclaration contained heein will mean the
non-approval of my/our application

Signature of Owner / Manager Date

 NOTARIAL ACKNOWLEDGEMENT

SUBCRIBED AND SWORN to before me this_______ day of ____________________ 20_______ in the

City/Municipality of ________________________________ Province of ______________________________,
Philippines, affiant exhibiting to me his/her Residence Certificate Number ______________________ issued at
____________________________________________ on ________________________.

NOTARY PUBLIC
Until December 31, 20
TIN No.
PTR No.
Date
Issued

MINIMUM DOCUMENTARY REQUIREMENTS

Duly accomplished Bagwis Application form

Business Name Certificate of Registration / SEC Registration Certificate / CDA Registration Certificate
Copy of latest Mayor’s Business Permit
Certificate of Accredited Service and Repair Shop (for Service and Repair Shop applicants only)

FOR DTI PURPOSES ONLY:

Step 1. Documents Screening Step 2. Certified - No Pending Case with DTI

(Documents – Complete and True) (Attach Certificate of No Pending Case - optional)

Note : __________________________________ Note : ___________________________________

Date of Evaluation (M/D/Y) : ___________________ Date of Issuance (M/D/Y): ____________________

Evaluated by : _____________________________ Issued by: ________________________________

Step 3. Conduct of On-Site Assessment Step 4A. Endorse to Regional Bagwis Committee for
(Attach On-Site Assessment Form - mandatory) Approval / Disapproval

Note : ___________________________________ Note : ___________________________________

Date of Evaluation (M/D/Y): Date of Deliberation (M/D/Y): __________________

Assessed by: RBC Secretariat:

Step 4B. Endorse to National Bagwis Committee for Step 5. Release of Seal & Certificate (Awarding Ceremony ,
Approval / Disapproval (GOLD NOMINEES) if applicable)

Note : Note :
 Date of Deliberation (M/D/Y): Date of Release (M/D/Y):

NBC Secretariat DTI Assigned Officer

Note: Please print to A4 paper (back to back) Page 1 of 2

 (Annex A

ASSESSMENT SHEET
(Revised as of March 2017)

Business/Trade Name: Date of Assessment:

Business Address: New/Upgrade Level:
Bagwis Category:
 Supermarket/Grocery  Department Store  Specialty Store
 Hardware Store  Convenience Store  Appliance Center

PARAMETERS / CRITERIA CHECK REMARKS

..
Factor 1: Compliance with Consumer Laws
Authenticity of the Products under Mandatory Standards
..Gift Check Policy
Labeling Requirements (i.e. Labels, PS/ICC Marks and Certificate)
..
Price Tag Law (i.e. Price Verification, Shelf Pricing, Price List)
Provisions of “No Return, No Exchange” Policy
.
Sales Promotion Guidelines
SRP of Basic Necessities & Prime Commodities
Factor B. Compliance with RA 9994 (SC) and RA 10754 (PWD
Factor C. Compliance with RA 10909 (No Shortchanging Act
Factor 2: Customer Relations and Services

. Presence of a Consumer Welfare Desk (CWD) or its equivalent (i.e. Customer Service
Area/Office) manned by a well-trained CWD officer/s

.. Existence of operating guidelines for consumer complaints handling (i.e. consumer

complaint forms, feedback mechanisms, records)
Existence of customer feedback mechanism (i.e. CSF)
..
Factor 3: Store Management and Operations
Clean and orderly workplace
.Placement of visible store signage/s
Issuance of official receipts/invoice to all consumer products and services sold

.Implementation of Green Measures (i.e. proper waste disposal and segregation, use of
energy efficient light bulbs, use of paper bag/eco bag instead of plastic
Factor 4: Socially Committed and Responsible Business Sector (FOR SILVER AND GOLD APPLICANTS ONLY)
Involvement and/or implementation in any regular (i.e. yearly, quarterly, monthly) corporate
. social responsibility programs and/or activities (i.e. cultural, socio-civic, environmental,
educational, religious)

..
Factor 5: Quality Orientation Management (FOR GOLD APPLICANTS ONLY
Established Company Vision, Mission, and Values
..Organizational Chart and Quality Policy
Operations Manual for Complaints Handling Mechanism
.Operations Manual for Sales, After Sales, and/or Service Procedures
Standard Forms (i.e. Complaints, Customer Survey Feedback, Repair/Service
Note: If disqualified, allot thirty (30) days period for reassessment or reconsideration. Put NA if Not Applicable

Name & Signature of Assessor

To be accomplished by DTI Provincial Office:

Remarks/Comments/Recommendation (for Approval or Disapproval):

To be accomplished by the Regional Bagwis Committee Members

Date Received: Date of RBC Deliberation Meeting:

Approved or Disapproved:
Signatures of RBC Members:

RBC Member 1 RBC Member 4 RBC Member 3 RBC Member 4

Regional Bagwis Committee Chairman

 (Annex A)

REMARKS
 (Annex A

ASSESSMENT SHEET FOR SERVICE AND REPAIR SHOPS

(Revised as of March 2017)

Business/Trade Name : ______________________________________________ Date of Assessment:

Business Address : ______________________________________________ New/Upgrade Level: _________________

PARAMETERS / CRITERIA CHECK () REMARKS CHECK REMARKS

Factor 1: Compliance with Consumer Laws

.
Factor A: Compliance with RA 7394 and FTLs including but not limited to:

. Price Tag Law (i.e. Price Verification, Shelf Pricing, Price List)

. Labeling Requirements (i.e. Labels, PS/ICC Marks and Certificate)

. Sales Promotion Guidelines

. *Warranty(i.e. replacement of spare parts as mandated by RA 7394)

. Provisions of “No Return, No Exchange” Policy

Authenticity of the Products under Mandatory Standards (i.e. Original/Genuine)
Factor B: Compliance with Accreditation of Service and Repair Shops (PD 1572)

. Display of Valid Certificate of Accreditation

with FTEB-BLAD or appropriate DTI PO Division
Note: Conduct on-site assessment

.
Factor 2: Customer Relations and Services
Presence of a Consumer Welfare Desk (CWD) manned by a well-trained CWD officer/s

. Existence of operating guidelines for consumer complaints handling (i.e. consumer

. complaint forms, feedback mechanisms, records)

Existence of customer feedback mechanism (i.e. CSF)

.
Factor 3: Store Management and Operations

. Clean and orderly workplace

. Placement of visible store signage/s

Issuance of official receipts/invoice to all consumer products and services sold

. Implementation of Green Measures (i.e. proper waste disposal and segregation, use of

. energy efficient light bulbs, use of paper bag/eco bag instead of plastic) 
*Display of simplified guide and procedures in availing repair services
Factor 4: Socially Committed and Responsible Business Sector (SILVER AND GOLD APPLICANTS ONLY)

. Involvement and/or implementation in any regular corporate social responsibility

programs, activities (i.e. cultural, socio-civic, environmental, educational, religious)

. Participating in government programs, projects and/or activities geared towards

community development building (i.e. Diskwento Caravan, OTOP) – if applicable

.
Factor 5: Quality Orientation (FOR GOLD APPLICANTS ONLY)

. Established Company Vision, Mission, and Values

. Organizational Chart and Quality Policy

. Operations Manual for Complaints Handling Mechanism

. Operations Manual for Sales, After Sales, and/or Service Procedures

Standard Forms (i.e. Complaints, Customer Survey Feedback, Repair/Service)
Note: If disqualified, allot thirty (30) days period for reassessment or reconsideration. Put NA if Not Applicable

Name & Signature of Assessor

To be accomplished by DTI Provincial Office:

Remarks/Comments/Recommendation (for Approval or Disapproval):

To be accomplished by the Regional Bagwis Committee Members

Date Received: Date of RBC Deliberation Meeting:

Approved or Disapproved:

Signatures of RBC Members:

RBC Member 1 RBC Member 4 RBC Member 3 RBC Member 4

Regional Bagwis Committee Chairman

 (Annex A)

SERVICE AND REPAIR SHOPS

of March 2017)

REMARKS

Name & Signature of Assessor

ional Bagwis Committee Members