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Doe Application For Registration (Annex4)

The document is an application for registration by a dealer or retailer to sell an LPG-filled pressure vessel with a trademark or tradename. It includes company details, establishment details, application details, and supporting documentary requirements. It must be submitted to the Department of Energy-Visayas Field Office for issuance of registration before sales can begin.

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228 views2 pages

Doe Application For Registration (Annex4)

The document is an application for registration by a dealer or retailer to sell an LPG-filled pressure vessel with a trademark or tradename. It includes company details, establishment details, application details, and supporting documentary requirements. It must be submitted to the Department of Energy-Visayas Field Office for issuance of registration before sales can begin.

Uploaded by

msigravity
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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Republic of the Philippines

DEPARTMENT OF ENERGY
Annex 4
September 2022

Application for Registration by a Dealer or Retailer – Authority to Sell a Trademark or tradename


(via LPG-filled pressure vessel)

Date: April 25, 2024 .

Department of Energy- Visayas Field Office


Energy Industry Management Division
3rd Floor, Escario Building, Escario Street
Cebu City

Dear Sir/Madam:

In compliance with the Department Circular No. 2022-11-0037, we wish to inform you of this application
with the following details below:

A. Company Details

1. Company Name:
2. Business Address:
3. GPS Coordinates (longitude & latitude):
4. Telephone Number:
5. Email Address:

B. Establishment Details

1. Establishment Business Name:


2. Business Address:
3. GPS Coordinates (longitude & latitude):
4. Telephone Number:
5. Email Address:

C. Application Details

1. Type of Application : ( ) First ( ) Additional

D. Supporting Documentary Requirements.

Certified true copy of the following:

1. Notarized certificate of the existence of a contract to sell duly signed by both the Dealer or
Retailer and the Trademark owner or Marketer;
2. LTO of Dealer or Retailer;
3. LTO of Trademark owner or Marketer;
4. DOE registration certificate - Trademark or tradename;
5. DOE registration certificate – LPG Seal; and
6. Notarized company secretary’s certificate of the authorized representative of the applicant.

3rd Floor, Escario Building, 731 Escario Street, 6000, Cebu City, Philippines
Tel. No. (Trunkline) (032) 253-2150, 253-3459, 253-7222
Website:http://www.doe.gov.ph; E-mail: [email protected]
Very truly yours,

___________________________________
Name, designation & signature of applicant
or authorized representative
Reminder/ Instructions:

1. Submit this application form with complete documentary attachments to DOE-VFO for the issuance of registration before the
start of sale of an LPG-filled pressure vessel with a Trademark or tradename;
2. Pay the application fee based on the DOE-VFO order of payment via cash, postal money order/manager's check or cashier’s
check payable to the Bureau of the Treasury;
3. Issuance of registration shall not be later than twenty (20) working days from the official receipt of the complete application; and
4. Refer to Sections 21 and 31 of this Department Circular on the DOE handling office of this application.

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )


CITY/MUNICIPALITY OF _____________ ) S.S

BEFORE ME, a Notary Public for and in the City/Municipality of ____________________, this ___
day of __________ 20__, personally appeared presenting his/her identification, to wit:

Competent Evidence of
Name Date & Place of Issue
Identity

known to me and to me known to be the same person who executed and voluntarily signed the foregoing
application, which he/she acknowledged before me as his/her own free and voluntary act and deed, and
with full authority to sign in that capacity.

This application consisting of _______ (__) original copy/ies submitted to DOE-VFO with complete
attachment, duly signed by the applicant.

IN WITNESS WHEREOF, I have hereto set my hand on the day, year and place above the written.

NOTARY PUBLIC

Doc No. ______


Page No. ______
Book No. ______
Series of 20______

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