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Application For Securing Certificate of Compliance (Coc) : (As Indicated in DTI / SEC / CDA Registration)

This document is an application for a Certificate of Compliance from a business. It requests information such as business ownership type, name, address, contact details, costs, permits, and supplier information. The applicant must sign and have the application notarized. The application is to secure regulatory approval to operate a retail fuel business.

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Francis Pascua Calumpit
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© © All Rights Reserved
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4K views

Application For Securing Certificate of Compliance (Coc) : (As Indicated in DTI / SEC / CDA Registration)

This document is an application for a Certificate of Compliance from a business. It requests information such as business ownership type, name, address, contact details, costs, permits, and supplier information. The applicant must sign and have the application notarized. The application is to secure regulatory approval to operate a retail fuel business.

Uploaded by

Francis Pascua Calumpit
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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OIMB/COR#023-COCDrev1

APPLICATION FOR SECURING CERTIFICATE OF COMPLIANCE (COC)

Type of Ownership:

Single Proprietorship Partnership Corporation

Business Name:
(as indicated in DTI / SEC / CDA Registration)

Name Dealer/Retailer: Start of Operation: _____ _____


(as indicated in DTI / SEC / CDA Registration)

Name of Applicant:
(Partner / Incorporator / Authorized Representative)

Complete Address of Retail Outlet:

Telephone No.: Cell Phone No.:

Fax No.: E-mail Address:

Cost of Investment: (Please attach detail of Project Cost)

Please write COMPLIED or NOT COMPLIED in the space provided

DENR-EMB ECC/CNC
Local Zoning Ordinance
Fire Safety Inspection Certificate
Business Permit
Building Permit

Do you have Tank Truck(s) for Hauling Liquid Fuels (Own-Use)? Yes No
(If YES, please attach additional requirements)

Supplier(s):

Address:

Telephone No.: Cell Phone No.:

Fax No.: E-mail Address:

______________________________________
(Signature over Printed Name of Applicant)

Before me, the undersigned authority, on this day personally appeared _____________________________________,
of ________________________________________, Known to me to be the person whose name is subscribed to the
(Business Name)
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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