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FO OIMB A2 011 Application Form

This application form is for securing a Standards Compliance Certificate for businesses involved in refilling, marketing, dealing, retailing, hauling, or operating an LPG facility. The form requests information about the business name, address, activities, facility details, LPG brands and sizes, number of workers, ownership details, and requires the applicant's signature to be notarized. Upon completion, the form is submitted to register or renew registration for the Standards Compliance Certificate.

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Michael Aloba
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296 views

FO OIMB A2 011 Application Form

This application form is for securing a Standards Compliance Certificate for businesses involved in refilling, marketing, dealing, retailing, hauling, or operating an LPG facility. The form requests information about the business name, address, activities, facility details, LPG brands and sizes, number of workers, ownership details, and requires the applicant's signature to be notarized. Upon completion, the form is submitted to register or renew registration for the Standards Compliance Certificate.

Uploaded by

Michael Aloba
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FORM FOR COR#010-016

APPLICATION FOR SECURING STANDARDS COMPLIANCE CERTIFICATE (SCC)


(REFILLER/MARKETER/DEALER/RETAILER/HAULER/FACILITY)

NEW RENEWAL

Business Name: _________________________________________________________________________

Office Address/ Contact No.:_______________________________________________________________

______________________________________________________________________________________

Activity/ies To Engage In:


Refiller Marketer Dealer Retailer Hauler

Facility for Registration : Refilling Plant Auto-LPG Dispensing Station


(storage tank/s capacity) (storage tank/s capacity)
_____________________ __________________________

Authorized LPG Brand/s and Size : _________________________________________________________

Number of Workers : ____________________________________________________________________

Date Started of Operation: _______________________________________________________________

Location/Complete address of LPG establishment (1 application per activity/facility):


_______________________________________________________________________________________

_______________________________________________________________________________________

Project Cost (pls. attach details): ____________________________________________________________

Ownership:

Single Proprietorship:
Name of Owner: ____________________________________________________________

Partnership:
Partners:
____________________________________________________________________

Corporation:
Authorized Representative/s: ____________________________________________________
Address: ____________________________________________________________________
Contact Details (including email address):__________________________________________
___________________________________________________________________________

_________________________________
Name and Signature of Applicant

Before me, the undersigned authority, on this day personally appeared


__________________________, (name), of _________________________________________ (name of
company), known to me to be the person whose name is subscribed to the foregoing instrument, consisting of
____ attachments including this page on which this acknowledgement is written, and upon his/her oath
acknowledged to me that he/she executed the same for the purposes and consideration therein expressed and
in the capacity therein stated.

Given under my hand and seal of office this ________day of ___________________, 20___.

NOTARY PUBLIC

Doc. No.
Page No.
Book No.
Series of ________________

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