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AF-Certificate of Creation of Local Chapter

This document is an application for registration of a local chapter of a labor organization with the Department of Labor and Employment. It collects information about the applicant organization, including contact details, leadership, and details about the company or establishment where union members are employed. It also documents the processing of the application, including checking for required documents and payment of registration fees. The application is then recommended for approval or denial and forwarded to the director for final approval or notice of non-compliance.

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Madel De Castro
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268 views

AF-Certificate of Creation of Local Chapter

This document is an application for registration of a local chapter of a labor organization with the Department of Labor and Employment. It collects information about the applicant organization, including contact details, leadership, and details about the company or establishment where union members are employed. It also documents the processing of the application, including checking for required documents and payment of registration fees. The application is then recommended for approval or denial and forwarded to the director for final approval or notice of non-compliance.

Uploaded by

Madel De Castro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PM-NCR-03.10-F-01.R.

01
BLR Form No.5, Series2016

Republic of the Philippines


DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. ____

APPLICATION FOR REGISTRATION OF CREATION OF LOCAL CHAPTER


PART I. INFORMATION ABOUT THE REPORTING ORGANIZATION Date Accomplished (mm/dd/yyyy)
To be accomplished by the applicant. Supply all required information. Misrepresentation, false statement or fraud in this
application or any supporting document is a ground for denial or cancellation of the legal personality of the local/chapter.

Name of Applicant Organization Contact Nos.


E-mail: ________________________________
Address Landline No: ___________________________
Mobile No:_____________________________

Name of Federation / National Union Contact Nos.


E-mail: ________________________________
Address Landline No: ___________________________
Mobile No:_____________________________

Charter Certificate No. PaddingDate of Issuance

Place of Operation of Union

Name of President of Local/Chapter Contact Nos.


(First Name) (M.I.) (Last Name)
E-mail: ________________________________
Landline No: ___________________________
Address
Mobile No:_____________________________

Gender
Padding

Date of CBL Ratification (If


(mm/dd/yyyy)
ratification was done on
Date Organized (mm/dd/yyyy)
successive dates, state dates of ratification (mm/dd/yyyy)

Name of Establishment / Company Industry Classification Coverage of the Bargaining Unit


(Pls. Refer to PSC in the TSSD)  Supervisory
 Rank and File
Address  If Educational Institution:
Teaching
 Non-Teaching
No. of Employees in the Company No. of Employees in the Bargaining Unit No. of Union Members
Male Male Male
Female Female Female
TOTAL TOTAL TOTAL
padding

I attest to the truth of the foregoing.

________________________________________________
President
(Signature over printed name)

Subscribed and sworn to before me at ___________________________________________________, Philippines, this


_______ day of _________________ 20 _______ with I.D. No. __________________________________________issued by
___________________________________________________ on _________________________________.

NOTARY PUBLIC

Doc. No. __________


Page No. __________
Book No. __________
Series of __________
PM-NCR-03.10-F-01.R.01

PART II. PROCESSING OF REQUIREMENTS Date Received:


(To be accomplished by the processor in the FO)

A. Checklist of Documents/Requirements. All the foregoing supporting requirements shall be certified under oath by the
Secretary or the Treasurer, as the case may be, of the local/chapter and attested by its President. All documents shall be
submitted in two (2) copies: one (1) original and one (1) duplicate.
[ ] Duly accomplished form
[ ] A Charter Certificate issued by the federation or national union indicating the creation or
establishment of the local/chapter
[ ] The names of the local/chapter’s officers, their addresses, and the principal office of the local/chapter
[ ] The local/chapter’s constitution and by-laws, provided that where the local/chapter’s constitution and
by-laws is the same as that of the federation or national union, this fact shall be indicated accordingly.

B. Verification (Processor to verify with the records on file with BLR)


[ ] Verified/checked that the federation or national union is a legitimate registered labor organization

C. Payment of Registration Fee


[ ] Registration Fee paid under O.R. No. Date
[ ] Registration Fee not paid

D. Recommendation on the Application


[ ] Recommending Approval with Certificate of Registration attached
[ ] Recommending Denial due to failure to comply with documentary requirements
(Pls. specify lacking documents)
1.
2.
3.

By:
Evaluator
(Signature over printed name)

Date

PART III. APPROVAL/DENIAL

A. Entry/Denial

[ ] Entered in the registry of legitimate labor organizations with duly signed Certificate of
Registration of Local/Chapter attached
[ ] Entry denied, with duly signed Notice of Non-Compliance

B. Respectfully endorsed to the Director


[ ] For approval of Registration of Creation of Local/Chapter
[ ] For approval of Notice of Non-Compliance

Recommended by:

________________ ________________
Director/Field Office Head Date

Approved for release.

_______________ ________________
Name of Releasing Officer Date

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