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    BAI-AHWD Form No. 1 Final

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    Brillantes JY
    This document contains an application form for registration under the Animal Welfare Act of 1998. The form requests information such as the applicant's name, address, type of animal facility or business, veterinarian details, and certifications attended. It also provides instructions on where to apply, required documents, and the schedule of fees for initial and renewal registrations depending on the type of animal establishment.

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    BAI-AHWD Form No. 1 Final

    Uploaded by

    Brillantes JY
    519 views2 pages
    This document contains an application form for registration under the Animal Welfare Act of 1998. The form requests information such as the applicant's name, address, type of animal facility or business, veterinarian details, and certifications attended. It also provides instructions on where to apply, required documents, and the schedule of fees for initial and renewal registrations depending on the type of animal establishment.

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    BAI-AHWD Form No. 1 final

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    This document contains an application form for registration under the Animal Welfare Act of 1998. The form requests information such as the applicant's name, address, type of animal facility or business, veterinarian details, and certifications attended. It also provides instructions on where to apply, required documents, and the schedule of fees for initial and renewal registrations depending on the type of animal establishment.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    519 views2 pages

    BAI-AHWD Form No. 1 Final

    Uploaded by

    Brillantes JY
    This document contains an application form for registration under the Animal Welfare Act of 1998. The form requests information such as the applicant's name, address, type of animal facility or business, veterinarian details, and certifications attended. It also provides instructions on where to apply, required documents, and the schedule of fees for initial and renewal registrations depending on the type of animal establishment.

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    © All Rights Reserved
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    of 2

    BAI-AHWD Form No.

    1 (Revised September 2016)


    Application No.: ___________________ Latest 1”x1” ID
    Picture of
    Republic of the Philippines Applicant/
    Department of Agriculture Authorized
    BUREAU OF ANIMAL INDUSTRY Representative
    Diliman, Quezon City

    APPLICATION FOR REGISTRATION


    under Republic Act No. 8485 otherwise known as the Animal Welfare Act of 1998 as amended by RA 10631

    ____________________________________
    Date

    Name of Applicant ________________________________________________________________________________________________________________________________________________________________


    Last Name First Name M.I.

    Address ____________________________________________________________________________________________________________________________________________________________________________

    Contact No/s _______________________________________________________________________________ TIN ___________________________________ Nationality________________________________

    Nature of Business/Type of Animal Facility

    [ ] Animal Boarding Facility [ ] Animal Shelter [ ] Poultry Farm [ ] Laboratory Animal [ ] Wildlife Rescue Center
    [ ] Aviary [ ] Pet shop [ ] Cattle/Goat Farm [ ] Racetrack/Equestrian Establishment [ ] Zoo
    [ ] Canine Facility/K9 Provider [ ] Crocodile Farm [ ] Monkey Farm [ ] Slaughterhouse/Poultry Dressing Plant
    [ ] Cattery [ ] Grooming Facility [ ] Ostrich Farm [ ] Stock Farm/Stockyard/Stud Farm/Coral
    [ ] Kennel [ ] Hog Farm [ ] Animal Pound [ ] Veterinary Clinic/Hospital
    [ ] Others (Please specify):

    Business/Trade Name ___________________________________________________________________________________________________________________________________________________________

    Type of Business Organization [ ] Sole Proprietorship [ ] Partnership [ ] Corporation [ ] Others (Please specify) _______________________

    Business Address _________________________________________________________________________________________________________________________________________________________________

    Contact No/s ___________________________________________________ Email Address _________________________________________________________ TIN ___________________________________

    Name of Veterinarian ____________________________________________________________________________________________________________________________________________________________


    Last Name First Name M.I.

    TIN_________________________________________________ PRC License No. ______________________ Valid Until __________________________________

    PTR No. ________________________________ Issued on ____________________________ Issued at ______________________________________

    Member of any Professional Organization/Association? [ ] Yes [ ] No

    If Yes, Name/s of Professional Organization/Association _____________________________________________________________________________________________________________________

    Has Attended Any Animal Welfare Seminar/Training? [ ] Yes [ ] No

    If Yes, Name/s of Training/Seminar Attended

    Training/Seminar Title Date Venue Organizer

    ___________________________________________________________ ____________________ __________________________ _____________________ ________________________________________________

    ___________________________________________________________ ____________________ __________________________ _____________________ ________________________________________________

    _________________________________________________________
    Applicant/Authorized Representative
    (Printed Name and Signature)

    SUBSCRIBED AND SWORN to before me, this ____________________ day of ____________________________________________________, 20____________________.

    The affiant exhibited to me his/her Community Tax Certificate No. _____________________________________ issued at ________________________________________________ on

    ______________________________________, 20______.

    Doc. No. ________________


    Page No.________________
    Book No. _______________
    Documentary Stamp
    Series of________________
    Affixed Here
    ___________________________________________________________
    Notary Public
    ______________________________________________
    Authorized BAI representative/
    RAWO

    RECOMMENDING APPROVAL:
    ______________________________________________
    Office

    (To be filled-up by BAI-AHWD/DA-RAWO)


    Registration Certificate No. _______________________ APPROVED:
    Date Issued ___________________________________
    Amount Paid___________________________________
    Official Receipt No.______________________________
    Date Issued____________________________________
    Remarks______________________________________
    [ ] New [ ] Renewal [ ] Amendment
    INSTRUCTIONS

    I.WHERE TO APPLY

    Registration forms (in triplicate) shall be secured from the BAI-Animal Health and Welfare Division (AHWD), Visayas Avenue,
    Diliman, Quezon City or from any DA-Regional Field Offices. The accomplished form together with all supporting documents
    shall be filed at the office of the Chief, BAI-AHWD for recording, evaluation, processing and assignment of registration number.

    II.DOCUMENTS REQUIRED

    _____________Mayor’s Permit for renewal registration (Photocopy)


    _____________Business Name with BDT/SEC (if corporation) and Articles of Incorporation (Photocopy)
    _____________ID picture of the Owner/General Manager and Veterinarian
    _____________Establishment’s/Facility’s Veterinarian PRC License, PTR and S2 License from PDEA, if applicable (Photocopy)
    _____________Notarized Employment Contract/MOA of the Veterinarian, when applicable (Photocopy)
    _____________Notarized valid Contract of Lease of the space/building occupied (Photocopy)
    _____________Location Plan/Sketch of the Establishment
    _____________Certification/s that the owner/veterinarian has attended seminar/s on Animal Welfare
    _____________Environmental Clearance Certificate (ECC) from the Department of Environment and Natural Resources (DENR)
    _____________Appropriate permits issued by DENR for wildlife facilities

    III.SCHEDULE OF FEES

    ESTABLISHMENT INITIAL RENEWAL


    (1 year) (3 years)
    Animal Boarding and Recreation Facility ₱ 300.00 ₱ 900.00
    Animal Show (Television) ₱ 1,000.00 ₱ 3,000.00
    Animal Show (Movie/Film) ₱ 5,000.00 ₱ 15,000.00
    Aviary ₱ 500.00 ₱ 1,500.00
    Canine Facility/Canine Security ₱ 300.00 ₱ 900.00
    Cattery/Kennel/Laboratory Animal Facilities/Pet Shops ₱ 500.00 ₱ 1,500.00
    Circus/Carnival/Animal Show ₱ 1,000.00 ₱ 3,000.00
    Crocodile Farm ₱ 1,000.00 ₱ 3,000.00
    Grooming Facility ₱ 300.00 ₱ 900.00
    Hog/Poultry/Cattle/Goat Farm ₱ 1,000.00 ₱ 3,000.00
    Monkey Farm ₱ 1,000.00 ₱ 3,000.00
    Ostrich Farm ₱ 300.00 ₱ 900.00
    Pounds/Shelters ₱ 200.00 ₱ 600.00
    Racetrack/Equestrian Establishment ₱ 500.00 ₱ 1,500.00
    Slaughterhouse/Poultry Dressing Plant ₱ 500.00 ₱ 1,500.00
    Small Animal Show ₱ 500.00 ₱ 1,500.00
    Stock Farm/Coral/Stockyard/Stud Farm ₱ 500.00 ₱ 1,500.00
    Veterinary Hospital/Veterinary Clinic ₱ 300.00 ₱ 900.00
    Wildlife Rescue Center ₱ 300.00 ₱ 900.00
    Zoo ₱ 1,000.00 ₱ 3,000.00
    Other related animal facilities ₱ 300.00 ₱ 900.00

    SURCHARGE: Upon renewal, a surcharge of 50% of the amount due shall be levied on every expired registration certificate.

    IV.DISPLAY OF REGISTRATION CERTIFICATE

    Registration Certificate shall be displayed conspicuously in the place of business and must be readily visible to the public.

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