Form AL – 01 (Revised 2016)

(THIS FORM IS FREE OF CHARGE AND CAN BE REPRODUCED)

APPLICATION FORM FOR LICENSE TO OPERATE
IMPORTANT: ALL ENTRIES MUST BE FILLED OUT ACCURATELY AND LIGIBLY

BUSINESS PROFILE
BUSINESS NAME: EMAIL ADDRESS:
CONTACT NUMBER:
SECURITY SERVICES PROVIDED: [ ] PRIVATE SECURITY [ ] ARMORED SECURITY [ ] PRIVATE DETECTIVE [ ] COMPANY SECURITY FORCE

NATURE OF OWNERSHIP: [ ] SOLE PROPRIETORSHIP [ ] CORPORATION [ ] PARTNERSHIP

INDICATE NUMBER OF BRANCHES IN ANY: _______Luzon _______Visayas ______ Mindanao
LICENSE TO OPERATE APPLIED FOR: [ ] NEW [ ] RENEWAL
NAME OF LICENSEE: SO LICENSE NUMBER VALIDITY
HOME ADDRESS CELLULAR PHONE NUMBER:
MANAGEMENT PROFILE
A. Administration/Operation
NAME LICENSE VALIDITY LICENSE NUMBER POSITION

B. Board of Directors (FOR CORPORATION ONLY)

Name Position

SECURITY PERSONNEL and FIREARMS PROFILE

Nature of Profession Number Caliber Number

Total Number Of Personnel Total Number Of FAs

LICENSE PROFILE (For old Applicant only)
Number of Years of Business Existence
License to Operate Number Authority and Date Granted Expiry Date

CRIMINAL/ ADMINISTRATIVE CASE PROFILE

Has licensee/agency been charged criminally/administratively/civilly in any court or quasi-judicial body within the Philippines?______
(If yes, please specify below)
Nature of Case Where and When Filed Status/Disposition

CERTFICATION
I hereby certify that, all statements provided and documentary requirements attached herein are true, correct, valid and authentic
and any misdeclaration/falsity stated therein shall be a basis for the cancellation/revocation of my License to Operate (LTO) without prejudice
to the filing of criminal and/or civil case against me.

SUBSCRIBED AND SWORN TO BEFORE ME THIS ____ DAY

OF ______________ 2016. APPLICANT EXHIBITED TO ME __________________________
HIS/ HER CTC NO. ______________ ISSUED IN __________ LICENSEE
__________________________ON___________________
DOC NO: _____
PAGE NO:_____
BOOK NO:_____
SERIES OF:_____ NOTARY PUBLIC