Republic of the Philippines

Province of Antique
OFFICE OF THE MUNICIPAL MAYOR

APPLICATION FOR BUSINESS LICENSE AND

PERMIT
TAX YEAR 2015
Instructions:
1.
2.
3.
4.

Provide accurate information and print legibly to avoid delays. Incomplete application form will be returned
to the applicant.
Ensure that all documents attached to this application form are complete and properly filled out.
Use BLACK INK (CAPITAL).
Please attach list of names of employees.

New
Renewal business Plate No.
Transfer: (If applicable
Ownership
Location

2015-00_____

Amendments : (If Applicable)

From Single to Partnership
From Single to Corporation
From Partnership to Single
From Partnership to
Corporation
From Corporation to Single
From Corporation to
Partnership

Date of Application:

DTI/SEC/CDA Registration No.:

Reference no.:

DTI/SEC/CDA Date of Registration:

Type of
Organization

Single

Partnershi
p

Coop

CTC No.:

Module of Payment
Annually
Bi-Annually
Quarterly

TIN:

Are you enjoying Tax Incentive from any Government Entity? ( ) Yes ( ) No. Please Specify Entity:
Name of tax payer:

Citizenship:

Last Name
Date of Birth
Business Name
Trade Name/Franchise:
Name Of President/Treasurer of Corporation:
Last Name

Sex

First Name

Middle Name

First
Name

Middle Name

Male

Female

Business Address
Owners Address
House No./Bldg. No.
House No./Bldg. No.
Building Name
Building Name
Unit No.
Unit No.
Street
Street
Barangay
Barangay
Subdivision
Subdivision
City/Municipality
City/Municipality
Province
Province
Tel No.
Tel No.
Email Address
Email Address
Property Index No.
Business Area (in sqm.):
# of Employees Residing in LGU
Total No. Of Employees in Establishments
No. of Male/
/Female/
/
If Place of Business is rented, please identify the following: Lessors Name
Monthly Rental
Lessors Address
House No./Bldg. No.
Subdivision
Street
City/Municipality
Barangay
Province
Tel. No.
Email Address
In case of Emergency
Business Activity
Code
Line Business

Contact Person/Tel. No./Mobile Phone No./Email Address

Gross Sales/receipts (for renewal
No. of Units
Capitalization (for new business)
Essential
Non-essentials

Oath of Undertaking: For those who cannot comply the requirements, an Oath of Undertaking shall be filled separately using
the forms furnished.
APPROVED
SIGNATURE OF APPLICATION OVER PRINTED NAME

JULIUS RONALD L.
PACIFICADOR

POSITON/TITLE:

Municipal Mayor

ASSESMENTS
LOCAL TAXES

REFEREN
CE

AMOUN
T DUE

PENALTY/
SURCHAR
GE

TOTAL

ASSESSED BY

Gross Sales Tax

Tax on Delivery/Trucks
Tax on Storage for
combustible/flammable
Tax on signboard/billboards
REGULATORY FEES AND
CHARGES
Mayors Permit Fees
Garbage Charges
Delivery Vans/Trucks Permit Fee
Sanitary Inspection Fee
Building Inspection Fee
Electrical Inspection Fee
Mechanical Inspection Fee
Plumbing Inspection Fee
Signboard/Billboard Renewal Fee
Signboard/Billboard Permit Fee
Storage and Sale on combustible
/flammable or explosive
substance
Others:
Previous Years Unpaid Business
Tax
and Other Fees
Description
Barangay Clearance
Zoning Clearance
Sanitary/Health
Clearance
Occupancy Permit
Fire Safety Inspection
Clearance
Others please specify

Office/Agency
Barangay
Zoning Admin.
City Health Department

Date Issued

Verified by (BPLO Staff)

Building Official
City Fire Department

APPROVED BY:
Assessment and Reviewed by: _____________________________________
MUNICIPAL TREASURER

CLEMENTE C. CAHILIG