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FSED 002 Application Form FSIC 07aug2018

This document is an application form for obtaining a Fire Safety Inspection Certificate (FSIC) from the Bureau of Fire Protection. The form requests information such as the business identification number, name of owner, trade name, business address, and type of FSIC being applied for. It lists the required documentary attachments based on the type of FSIC. The applicant must certify the correctness of the information and sign the form.

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Jr Catapang
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2K views1 page

FSED 002 Application Form FSIC 07aug2018

This document is an application form for obtaining a Fire Safety Inspection Certificate (FSIC) from the Bureau of Fire Protection. The form requests information such as the business identification number, name of owner, trade name, business address, and type of FSIC being applied for. It lists the required documentary attachments based on the type of FSIC. The applicant must certify the correctness of the information and sign the form.

Uploaded by

Jr Catapang
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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BUREAU OF FIRE PROTECTION

AUTOMATED CLEARANCE SYSTEM


Service Made FAST- EASY - RELIABLE (02) 426 0219 / 426 0246 www.bfp.gov.ph
FSIC
APPLICATION FORM
CHECK BOX OF CLEARANCE APPLIED FOR
FIRE SAFETY INSPECTION CERTIFICATE
FIRE SAFETY INSPECTION CERTIFICATE For Issuance of Business Permit/ Certificate of
FIRE SAFETY INSPECTION CERTIFICATE

For Issuance of Occupancy Permit Annual Inspection for PEZA


NEW BUSINESS RENEWAL

Business Identification Number (BIN) Tax Identification Number (TIN)

NAME OF OWNER
ESTABLISHMENT
NAME
TRADE BUSINESS
NAME NATURE
EXACT BUSINESS
ADDRESS
LANDLINE/FAX CELLPHONE NUMBER EMAIL ADDRESS

AUTHORIZED REPRESENTATIVE
(If Applicant is not the Owner)

ATTACHED DOCUMENTARY REQUIREMENTS


FSIC FOR OCCUPANCY PERMIT FSIC FOR BUSINESS PERMIT
[ ] COPY OF APPLICATION FORM FOR CERTIFICATE OF [ ] BUSINESS PERMIT APPLICATION FORM OR TAX ASSESSMENT
OCCUPANCY FROM OFFICE OF THE BUILDING OFFICIAL BILL FROM THE BUSINESS PERMIT AND LICENSING OFFICE
OR ASSESSMENT OF FEES FROM OBO [ ] COPY OF FIRE INSURANCE (IF ANY)
[ ] PHOTOCOPY OF CERTIFICATE OF COMPLETION [ ] AFFIDAVIT OF UNDERTAKING OF NO
[ ] AS-BUILT PLAN (If Necessary) ALTERATION TO BUILDING (For NEW Business
with Valid FSIC Issued for Occupancy)
NOTE: Incomplete documentary requirements will be returned to
the applicant.
I hereby certify the correctness of the information provided above and the completeness of the attached
documents.

________________________________ _____________________
SIGNATURE OVER PRINTED NAME DATE

VERIFIED BY: DATE RECEIVED


TIME RECEIVED
BFP-QSF-FSED-002 REV.00 (06.01.18)

CONTACT INFORMATION: ____________________________________ email: __________________________________


NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card

DATE CUSTOMER RELATION OFFICER


______________________ _________________________
CERTIFIED BY:

APPLICATION
FSIC CLAIM STUB

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