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Application Form For Business Permit

This document is an application form for a business permit for the tax year 2015 from the City of Surigao. It provides details about the applicant, David Peñaloga Puspus, who is applying as the sole proprietor of a quarrying business called Datu Maghuhukum Mineral Resources and Development. The application includes information such as the business address, owner's address, number of employees, capitalization, and required clearances. It also contains an undertaking section where the applicant agrees to comply with regulatory requirements and provide truthful information.

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Malouz Zerda
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867 views2 pages

Application Form For Business Permit

This document is an application form for a business permit for the tax year 2015 from the City of Surigao. It provides details about the applicant, David Peñaloga Puspus, who is applying as the sole proprietor of a quarrying business called Datu Maghuhukum Mineral Resources and Development. The application includes information such as the business address, owner's address, number of employees, capitalization, and required clearances. It also contains an undertaking section where the applicant agrees to comply with regulatory requirements and provide truthful information.

Uploaded by

Malouz Zerda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Application Form for Business Permit

TAX YEAR 2015

CITY OF SURIGAO
Permit No. Control No. 4012
New Amentment: Mode of Payment
Renewal From Single to Partnership Annually
Additional From Single to Corporation Bi-Annually
Transfer: From Partnership to Single Quarterly
From: From Partnership to Corporation
Transfer
To: From Corporation to Single
From: From Corporation to Partnership
Location
To: DTI/SEC/CDA Registration No.: 01467384
Date of Application:
Reference No.: DTI/SEC/CDA date of registration: 28th July 2011
Type of Organization: ( ) Single ( )Partnership ( )Corporation ( )Cooperative CTC No. 3517487 TIN: 403-433-735
Are you enjoying tax incentive from any Government Entity? ( ) yes ( ) no Please specify the entity?
Name of Last Name: First Name: Middle Name
Tax Payer PUSPUS DAVID PEÑALOGA
Nature of Business: QUARRYING (Ordinary Earth Soil)
Trade name/ Franchisee: Datu Maghuhukum Mineral Resources and Development
Name of President/ Treasurer of Corporation: DAVID P. PUSPUS
Last Name: First Name: Middle Name:
PUSPUS DAVID PEÑALOGA
Business Address Owner’s Address
House No./ Bldg No. House No./ Bldg No.: 10771
Building Name: Building Name: Mrs. Angelene Hoy
Unit No. Unit No.: Blk. 8 – Lot 11
Street Street: Lipata Road
Barangay: Mabini Barangay: Barangay Rizal
Subdivision Subdivision: Pepang
City/Municipality: Surigao City City/Municipality: SURIGAO CITY
Province: Surigao Del Norte Province: SURIGAO DEL NORTE
Tel. No.: 0998-385-1609 Tel. No.: 0998-385-1609
Email Address: [email protected] Email Address: [email protected]
Property Index Number (PIN):
Business Area (in sq.m.) Total No. of Employees in Establishment # of Employees Residing in LGU:
15,000 SQ.M. 12 4
If Place of Business is Rented, please identify the following: Monthly Rental:
Lessor’s Name

Last Name: First Name: Middle Name:


PUSPUS DAVID PEÑALOGA
Lessor’s Address: P-1A Buhangin Pob. (Brgy. 19) Butuan City, Agusan del Norte
House No/Blg. No. # 137 Subdivision: PEPANG
Street City/Municipality: SURIGAO
Barangay: Barangay 19, Butuan City Province: Surigao del Norte
Tel.No.: 09983851609 Email Address:
In case of Emergency: ERNESTO FEREJAN Contact Person/Tel./Mobilephone No./Email Address:

Business Actvity Capitalization Gross Sales/Receipts (For renewal)


Code Line of Business No. of Units (for new business) Essential Non-Essential
QUARRYING P500,000.00

DAVID PEÑALOGA PUSPUS SOLE PROPRIETOR


Signature POSITION/ TITLE
Note: Reissuance of this application form will cost P30.00
Application Form for Business
UNDERTAKING
1. All Information supplied in this application are true and correct to the best of my belief and knowledge.
2. Any false or misleading information supplied, or production of materially false or misleading documents to
support the application shall be a ground for the appropriate criminal, civil and or administrative action against
me.
3. To comply with the regulatory requirements and other deficiencies within 30 days from release of business
permit (zoning clearances, building permit, police/ fire clearance, health/ sanitary certificate)
4. Failure to comply shall cause revocation/ cancellation of the business permit issued.

DAVID PEÑALOGA PUSPUS SOLE PROPRIETOR


Signature of Applicant Over Printed Name POSITION/ TITLE

VERIFICATIONS OF DOCUMENTS
Description Office/Agency Date Issued VERIFIED BY: REMARKS

Barangay Clearance Barangay

Zoning Clearance Zoning Admin

Occupancy Permit Bldg. Official

Fire Safety Inspection Certificate City Fire Dept.

Sanitary/ Health Clearance City Health Dept.

___________________________ ___________________________
Application checked by: Application checked by:

Instructions:
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 application form are complete and properlty filled out.

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