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REQUIREMENTS FOR ISSUANCE OF CERTIFICATE OF GOOD

STANDING:

____________ __ 1. Payment of GEP Annual Dues (current): must have no arrears

____________ __ 2. Attendance in any two (2): National Convention; Regional

Convention and SLAA

____________ __ 3. Payment of Survey Fee submitted to DENR

____________ __ 4. Payment for GEP-NCR Certificate fee

APPLICATION FORM

Name: ____________ _________ _________ _________ _________ _________ _________


_________

Address: ____________ _________ _________ _________ _________ _________ _________


________

Tel. No. ____________ _________ _________ _________ __ Cell. No. ____________


_________ ___

PRC Lic. # ____________ _________ __ Dated: ____________ _ Expiry Date: ____________


___

CTCNo.: ____________ _________ _____ Dated: ____________ _____ Place: ____________


____

Current PTR No.: ____________ _________ __ Dated: ____________ _____ Place:


___________

TIN:________ _________ _________ _____


GEP O. R. No. ____________ _________ _________ ___ Dated: ____________ _________
___

____________ _________ ______

Signature of Applicant

Note: Please up date your Address, Contact Number & your Data Information

GEODETIC ENGINEERS OF THE PHILS. INC.

National Capital Region

FIRST NAME: ____________ _________ _________ _________ _________ _________ _

MIDDLE NAME: ____________ _________ _________ _________ _________ ________

LAST NAME: ____________ _________ _________ _________ _________ _________ __

BIRTHDAY: ____________ _________ _________ _____ BIRTH PLACE: ____________


_________ _______
CIVIL STATUS______ _________ _________ _________ SEX: ____________ _________
_________ ________

RES. MAILING ADDRESS: ____________ _________ _________ _________ _________


_________ _________

HOME TELEPHONE NO.: ____________ _________ ________ MOBILE NUMBER


____________ ________

COLLEGE GRADUATED FROM:_______ _________ _________ _________ _________


_________ _________

E-MAIL ADDRESS: ____________ _________ _________ _________ _________ _________


_________ _______

COMPANY: ____________ _________ _________ _________ _________ _________


_________ _________ _____

OFFICE ADDRESS: ____________ _________ _________ _________ _________


_________ _________ _______

WORK TELEPHONE NO.: ____________ _________ ________ FAX. NUMBER:


____________ _________ __

GEP ID CARD: ____________ _________ _________ _________ _________ _________


_________ _________ __

PRC ID CARD: ____________ ____ DATE ISSUED:_____ _________ ___DATE


EXPIRED ____________ ___

PROFESSIONAL TAX RECEIPT: ____________ _ DATE ISSUED: ____________


PLACE: ____________

COMMUNITY TAX CERT.: ____________ ____ DATE ISSUED: ____________ PLACE:


____________ __

TAX IDENTIFICATION NUMBER:_____ _________ _________ _________ _________


_________ _________ _

SIGNATURE:

NOTE: PLS. PRINT YOUR COMPLETE DATA INFORMATION


____________ _________ _________

DATE MEMBERSHIP

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