ICARE FORM (REVISED 2010)

Republic of the Philippines

Department of Finance

Bureau of Customs
1099 Manila
INTERIM CUSTOMS ACCREDITATION AND REGISTRATION (ICARE) UNIT
REVENUE COLLECTION MONITORING GROUP

APPLICATION FOR ACCREDITATION

PARTNERSHIP

CORPORATION

COOPERATIVE
NEW
APPLICANT

RENEWAL
REPRESENTATIVE

NAME: _____________________________________________________________________________________
_
Middle Name

Surname

First Name

NAME OF FIRM
:_______________________________________________________________________________
Head Office Address:
___________________________________________________________________________
City/Province

No./Bldg.
Zip Code

Street

Year/s of Stay in the Premises:__________

Nature of Occupancy: ( ) Owned
( ) Leased

Barangay

( ) Shared

Others:_______________
Warehouse
:________________________________________________________________________
Year/s of Stay in the Premises:__________
Nature of Occupancy: ( ) Owned
( ) Leased ( ) Shared

Address

Others:_______________
Branch
Office
Address:_________________________________________________________________________
Year/s of Stay in the Premises:_____________________________________
Nature of Occupancy: ( ) Owned
( ) Leased ( ) Shared
Others:________________
Telephone Number/s: ____________________________________________
Facsimile Number/s: _____________________________________________
Email Address: _________________________________________________
Company TIN: __________________________________________________
Previous Certificate of Accreditation No.:____________________________________________

PERSON MANAGING THE AFFAIRS OF THE FIRM:

Name: _______________________________________________________________
Designation: __________________________________________________________
Telephone Number/s: ___________________________________________________
Specimen Signature: ______________________________________________________
ATTACHMENTS

NEW APPLICATION
Special
Power
Attorney/Board
Resolution
Authorized Representative

RENEWAL OF ACCREDITATION
of
of

BCOR evidencing payment

of registration fee

Special
Power
Attorney/Board
Resolution
Authorized Representative

BCOR evidencing payment

of registration fee

Printed CPRS Application

profile

of
of

Printed CPRS Application

profile

Mayors Permit
Barangay Clearance
BIR TIN Card and/or VAT
(or
Non-VAT)
Certificate
of
Applicant
Valid Government Issued
ID with Photo (e.g. Passport,
Drivers
License,
etc.)
and
Community Tax Certificate of the
Applicant
For
Corporation,
SEC
Certificate
of
Registration,
Articles of Incorporation and ByLaws
and General Information
Sheet as may be applicable

Affidavit of NO CHANGE of
CIRCUMSTANCE (in case no
material changes in the data and
circumstances as appearing in
previous
Application
for
Accreditation)
Current Mayors
and Barangay Clearance

Permit

Certified True Copy of

Income Tax Return for the past
three (3) years, if applicable
Certified True Copy of VAT
Returns for the past three (3)
years, if applicable

N.B.: In case there are changes

For
Partnerships,
SEC
the material information
Certificate
of
Registration, in
previously
declared and filed,
Articles of Partnership and Bythe applicant, in addition to the
Laws

above

requirements,

shall

For
Cooperatives,
Certificate of Cooperation issued instead submit an Affidavit of
by the Cooperative Development Change of Circumstance clearly
stating the facts constituting
Authority

the changes, together with the

Audited
Financial
Statements for the past year, if necessary documents in support
thereof.
applicable
Bureau of Investments
(BOI) Certificate of Registration, if
applicable
Income Tax Return of the
Company/Partners for the past
three (3) years, if applicable
Certified True Copy of VAT
Returns for the past three (3)
years, if applicable
Proof of ownership or
lawful occupancy (i.e. Contract of

Lease) of the business premises,

as the case may be.
Proof of Utility Billing
Company
Profile
Pictures of Premises

with

Location Map of Principal

Place of Business
Capital Structure
Personal
Profile
of
Corporate Officers and Company
Representatives
OTHER INFORMATION:
Nature of Business:_____________________________________________________
Main Line of Business: __________________________________________________
Secondary Line of Business:______________________________________________
Other Business Activities: ________________________________________________
List of Importable Items:

Commodity
Volume (1 Year Pd.)
________________________________ ________________________________
________________________________ ________________________________
________________________________ ________________________________
Amount of Capital Invested: ______________________________________________
Interest in Other Business/Enterprise (if any)

Name of Firm
No

__________________
__________________
__________________

Nature of Interest
___________________ _
___________________ _
___________________ _

SEC Reg.
_________________
_________________
__________________

I hereby certify under oath that:

1. All information supplied in this application are true and correct to the
best of my belief and knowledge;
2. All documents submitted to support this application are genuine and
true; and
3. Any false or misleading information supplied, or production of
materially false or misleading document to support the application
shall be a ground for the appropriate criminal, civil and or
administrative action against me.
____________________________________

PHOTO
Authorized Signatory

Signatory of Applicant /

2 x 2
____________________________________
Position

____________________________________
Name of ApplicantImporter

SUBSCRIBED AND SWORN TO before me this ____th day of ______________2010

in ______________, Philippines ; affiant exhibiting to me his / her Community Tax
Certificate No. _____________________ issued in _________________________on
____________________.
NOTARY
PUBLIC
(Until December
___)
Doc. No.:
Page No.:
Book No.:
Series of: