BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049)
(049) 511-9111
511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Regional Office 4A
Laguna Provincial Office
Biñan Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111 (Station Email)
FSIC
APPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
BFP-QSF-FSED-002 REV.02 (08.24.20)
 PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

FSIC
“FIRE SAFETY IS OUR MAIN CONCERN”
BUREAU OF FIRE PROTECTION
Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station binanfirestation
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111 @yahoo.com APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email)
FSIC
APPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
BFP-QSF-FSED-002 REV.02 (08.24.20)
 CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email)
FSIC
APPLICATION NUMBER

CLAIM STUB
BFP-QSF-FSED-002 REV.02 (08.24.20)
 CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

BFP-QSF-FSED-002 REV.02 (08.24.20)

(Region)
(District/Provincial Office)
(Station)
(Station Address)
FSIC
APPLICATION NUMBER
 (049) 511-9111 (Station Email)

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BFP-QSF-FSED-002 REV.02 (08.24.20)

 BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email) APPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

BFP-QSF-FSED-002 REV.02 (08.24.20)

 PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email)
FSICAPPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
BFP-QSF-FSED-002 REV.02 (08.24.20)
 DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email)
FSIC
APPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
DATE/TIME

BFP-QSF-FSED-002 REV.02 (08.24.20)

 VERIFIED BY BFP-CRO: _____________________________
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email)
FSIC
APPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

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.

______________________________________________________________ ________________
BFP-QSF-FSED-002 REV.02 (08.24.20)
 OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email)
FSIC
APPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
(049) 511-9111
binanfirestation
@yahoo.com
FSIC
APPLICATION NUMBER

FIRE SAFETY INSPECTION CERTIFICATE APPLICATION FORM

CHECK BOX OF CERTIFICATE APPLIED FOR
NAME OF OWNER
BUILDING/FACILITY/STRUCTURE/BUSINESS/
ESTABLISHMENT NAME
EXACT ADDRESS
AUTHORIZED REPRESENTATIVE
TYPE OF OCCUPANCY/ BUSINESS NATURE
TOTAL FLOOR AREA (M2) : NO. OF STOREY:
CONTACT NUMBER : EMAIL ADDRESS:
ATTACHED DOCUMENTARY REQUIREMENTS
FSIC FOR CERTIFICATE OF OCCUPANCY
[ ] ENDORSEMENT FROM OFFICE OF THE BUILDING OFFICIAL (OBO)
[ ] CERTIFICATE OF COMPLETION
[ ] CERTIFIED TRUE COPY OF ASSESSMENT FEE FOR SECURING CERTIFICATE OF OCCUPANCY FROM OBO
[ ] AS-BUILT PLAN (IF NECESSARY)
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE AND COMMISSIONING REPORT (FSCCR) (IF NECESSARY)
FSIC FOR BUSINESS PERMIT

FOR NEW BUSINESS FOR RENEWAL OF BUSINESS

[ ] CERTIFIED TRUE COPY OF VALID CERTIFICATE OF OCCUPANCY [ ] ASSESSMENT OF THE BUSINESS PERMIT FEE/TAX
[ ] ASSESSMENT OF BUSINESS PERMIT FEE/ TAX ASSESSMENT BILL FROM BPLO
ASSESSMENT BILL FROM BPLO [ ] COPY OF FIRE INSURANCE (IF NECESSARY)
[ ] AFFIDAVIT OF UNDERTAKING THAT THERE WAS NO [ ] ONE (1) SET OF FIRE SAFETY MAINTENANCE REPORT
(FSMR) (IF NECESSARY)
SUBSTANTIAL CHANGES MADE ON
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING
BUILDING/ESTABLISHMENT AND OTHER HOT WORK OPERATIONS (IF REQUIRED)
[ ] COPY OF FIRE INSURANCE (IF NECESSARY)

NOTE: Incomplete documentary requirements will be returned to the applicant.

BFP-QSF-FSED-002 REV.02 (08.24.20)
 I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________________________ ________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

_______/__________
VERIFIED BY BFP-CRO: _____________________________ DATE/TIME
FSIC MONITORING (TO BE FILLED-UP BY BFP PERSONNEL ONLY)
CRO FCA FCCA C,FSES FSI C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-002 REV.02 (08.24.20)

BUREAU OF FIRE PROTECTION

(Region)
(District/Provincial Office)
(Station)
(Station Address) (049) 511-9111 (Station Email)
FSICAPPLICATION NUMBER

CLAIM STUB
CERTIFIED BY:

_______________________ ___________________
CUSTOMER RELATION OFFICER
DATE
NOTE: AUTHORIZED REPRESENTATIVE MUST PRESENT AN AUTHORIZATION LETTER AND COPY OF OWNER’S IDENTIFICATION CARD
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-002 REV.02 (08.24.20)