City of Talisay: Requirements: 1. Brgy. Clearance 2. Dti/Sec/Cda 3. Sanitary Permit 4. Others

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Republic of the Philippines

Requirements:
1. Brgy. Clearance Province of Negros Occidental
2. DTI/SEC/CDA CITY OF TALISAY
3. Sanitary Permit
4. Others: OFFICE OF THE CITY MAYOR
_________________ Business Permits and Licensing Office

INSTRUCTIOINS:
1. Provide accurate information and print legibly to avoid delays. Incomplete application form will be returned to the applicant.
2. Ensure that all documents attached to this form (it any) are complete and properly filled out.

New Renewal Mode of Payment Annually Semi-Annually Quarterly


Date of Application: DTI/SEC/CDA Registration No.:
TIN NO.: DATE:
Type of Business: Single Partnership Corporation Cooperative
Amendment From: Single Partnership Corporation
Amendment To: Single Partnership Corporation
Are you enjoying tax incentive from any Government Entity? Yes No Pls. specify the entity:
Name Taxpayer/Registrant
Last Name: First Name: Middle Name:
Business Name:
Trade Name/Franchise:
2.OTHER INFORMATION (Note: For renewal application, do not fill up this section unless certain information have changed.)
Business Address:
Postal Code: Email Address:
Telephone No.: Mobile No.:
Owner's Address:
Postal Code: Email Address:
Telephone No.: Mobile No.:
In case of enmergency, provide name of contact person:
Telephone/Mobile No.: Email Address:
Business Area (in sq. m.): No. of Employees of the Establishment: No. of Employees Residing
within the LGU:
Male Female
(Note: Fill up Only If Business Place is Rented)
Lessor's Full Name:
Lessor's Full Address:
Lessor's Telephone/Mobile No.:
Lessor's Email Address:
Monthly Rental:
3. BUSINESS ACTIVITY
Capitalization Gross Sales/Receipts (For Renewal)
Line of Business No. of Units
(For New Businesses) Essential Non-Essential

I DECLARE UNDER PENALTY OF PERJURY that the foregoing information are true and correct Assessment conducted by:
based on my personal knowledge and authentic records. Further, I agree to comply with the
prescribed regulatory requirements, as well as, all order defeciencies within Thirty (30) days
from release of the business permit.

LEVI O. DORONILA
SIGNATURE OF APPLICANT/TAXPAYER OVER PRINTED NAME OIC City Treasurer

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