Annex 1

0Erltlxflt, oF
IRIIIEIIIIUFIf,Y
PltttfPttil
APPTICATION FOR REGISTRATION AS
-
BARANGAY MtcRo BUSTNESS ENTERPRTSE (BMBE)

BMBE Form 0I
Date Application Filed
Application.No,

ElN.* ElR"nr*ur
Certificate No.
Date Registered: Name of Business Enterprise
(DTI Namel SEC Regtsteied Nane)
- Business Name iSECBusiness
DTI Registranon NoiCD,{Registratian No.

Name of Owner (if Sole proprietor)

(Last Name) (First Name) (Middle Name)

Evu" Eremal"
Business
Telephone No
Address (Unit No:). gtrcet) IbffieNo:
_(Barangay) (iubdivision) Fax No
(Ci tyMunicipality) _____ (province) Email
Branches ({any)
Type of Business Organization
E Single proprietorship EPartne.ship Ecorporation ElCooperative
EAssociation Otlrers
Status of Business
EN"'.n E|E*istine
Principal Business Activitv
ElProduction EProcessing ElManufacturing Elrrading
t-l
LJ Services (Excluding those rcndered bv anyone who is Eorn"..
duly licensed by the government after having passed a
govemment licensure examination in connection with
the
exercise of one's profession)
Product Lines/Services
Other Businesses if any
Ey", ElNo If yes, how many?
Total Assets (To the nearest Thousand pesos excluding
rh" r"lr;;;;;;;;;",
uhich the b$iness. entiq:'s. ffice, plant and. equipmew. are tocated)

Total Number of Employees No. ofMales: No. ofFemales:

Regular: Irregular/Part+ime:
UI\IDERTAKING
rAue hereby declare, forpurposessf section.5 sf RA 9178, that
all inforrnation, including the businessenterprise,s.
asset size, supplied in this application which shall, be trp
lasis "i;;";G my eligibility for registerrng as BMBE are
true and correct to the best of my belief and knowledge. Any rarse J. misleading information supplied, and/or
production of materially false or misleadrrg document to
support this application shall be ground for disapproval of
BMBE application/revocation of BMBE certificate or euinority
as gromd for criminal, civil and/or
administrative action against our enterprise. I affirm under the p"nuttlo^'*"tt
ofperlury, that this declaration has been made
in eood faith.

vwe undertake to advise the Departrnent of Trade. and Industry though the
Negosyo center of any change in the
status of its ownership structure and shall surrender the original
.op[ or the s-Mbn Certificate of Authority for
notation of the transfer.

Applicant's/Authorized Representative s Signature