dti application for contractor's license

PCAB Form No. 101

APPLICATION FOR CONTRACTOR'S LICENSEwith the PHILIPPINE CONTRACTOR'S ACCREDITATION BOARD

The following pertinent documents and information are to be submitted in support of the license application of said firm:

Checklist for New License Application A. Legal[ ] 1. General Information (PCAB Form Nos. 101a and 102);

[ ] 1.1 For Sole Proprietorship: Certified true copy of BTRCP Certificate of Registration with pertinent BTRCP Form No. 16; For Partnership or Corporation: Certified true copy of SEC Certificate of Registration and Articles of Partnership/Incorporation and By-Laws showing Construction as Primary Purpose and subsequent amendments thereto;

[ ] 2. Authorized Managing Officer (AMO) Nomination: [ ] 2.1 AMO Affidavit (PCAB Form No. 103) with a passport size picture of AMO; For corporations only: Original Corp. Secretary's certificate as to the nomination of the AMO (PCAB Form No. 104); [ ] 2.2 Original NBI clearance of Filipino AMO; [ ] 2.3 If AMO is Non-Filipino (in addition to 2.1): [ ] 2.3.1 Working visa [ ] 2.3.2 Alien Certificate of Registration; [ ] 2.3.3 NBI clearance if AMO has resided in the Philippines for six (6) months or longer if not, equivalent clearance from AMO's home country duly authenticated by the Philippine embassy.

Note: For Corporations or Associations with foreign shareholders, the following documents must be submitted:

1. Corporate Secretary’s Certification as follows:a.List of stockholders showing their nationalities and shareholdings; andb.List of Board of Directors showing their names and nationality.

2. Copy of latest General Information Sheet duly filed with SEC showing the names of stockholders and directors, nationality and shareholdings.

The percentage control of the number of seats occupied by foreigners in the Board of Directors must not exceed the percentage of foreign shareholdings.B. Financial

[ ] 3. Financial Statements dated within the last six (6) months immediately preceding the filing of application (duly audited and signed on every page by an Independent and PRC-BOA accredited external auditor) and a diskette/CD (compact disc) containing the firm’s Audited Balance Sheet & Income Statement in the prescribed template (PCAB Financial Statement Forms A & B downloadable from the DTI website at www.dti.gov.ph together with pertinent application forms). [ ] 3.1 For old companies, copy of the Quarterly or Annual Income Tax Return certified true by the BIR, covering the income reported in the Audited Income Statement submitted for the quarter or taxable year immediately preceding the filing of application, whichever is applicable;

[ ] 3.2 Cash :Original copy of Bank Certification/Bank statement of account certified by Bank Manager of cash deposits as of the Balance Sheet date; Note: (Amount in excess of ½ of 1% of the minimum networth required for category applied for or P 50,000.00 whichever is higher, reflected as “Cash” or “Cash on Hand” will be deducted from the networth, If insupported.) [ ] 3.2.1 Authorization to Depository Bank (PCAB Form No. 105); [ ] 3.3 List of Land and Building/s owned by the company and registered in its name (PCAB Form No. 106a); [ ] 3.3.1 Certified true copy of TCT including back page; [ ] 3.3.2 Deed of Sale or Certified True Copy (CTC) of Tax Declaration of Land / Bldg., owned by the firm. [ ] 3.4 List of Construction and/or Transportation/Delivery Vehicles/Equipment/Machineries/Plants owned by the company and registered in its name (PCAB Form No. 106b);

[ ] 3.4.1 Certified true copy by the LTO of the LTO Certificate of Registration and current Official Receipt of Registration of registrable Construction and/or Transportation/Delivery Vehicles/Equipment reported;

[ ] 3.4.2 Certified true copy of Deed of Sale or sales invoices/official receipts for non-registrable construction equipment/machineries/plants;

[ ] 3.5 Additional documents to be submitted only if the values of each of the applicant's Inventories and Receivables Accounts exceed more than 20% of the contractor’s Networth, otherwise, the amount in excess of said account shall be deducted from networth. [ ] 3.5.1 Schedule of Inventories. (PCAB Form 107);

[ ] 3.5.2 Schedule of Receivables. (PCAB Form 107); [ ] 4. Authorization to BIR & other agencies (PCAB Form No. 105a);

C. Technical[ ] 5. List of Sustaining Technical Employee/s - STE (PCAB Form No. 106c) supported by the following documents for each STE: [ ] 5.1. STE Affidavit/s (PCAB Form No. 108) with a passport size picture/s of the nominated STE/s; [ ] 5.1.1 Certified true copy by PRC of valid PRC ID of STE as licensed professional or original

Certification of Good Standing from PRC; [ ] 5.1.2 Original NBI Clearance/s of newly nominated STE/s; [ ] 5.2 STE Affidavit/s of Construction Experience (PCAB Form No. 109); [ ] 5.3 Personal Appearance Form duly accomplished and signed by the STE/s appearing before the designated

officer of the PCAB or the nearest DTI regional/provincial office (PCAB Form No. 110)

D. Original Signature of AMO on each and every page of the application forms includingsupporting documents (except item 5.3)

The Board may require the AMO interview and submission of pertinent documents/information other than the above in order to fully determine the qualifications of the applicants;

AMO/Applicants for TRADE category may no longer be required to take the AMO examinations. Photocopies of documents, in lieu, of certified copies are accepted provided the original copies are presented for

authentication

DO NOT FILL (For PCAB use only)Total No. of Pages Submitted: _______ Checklisted by: ________________________________ [ ] Self-stamped envelopes * (no. ______ ) Signature Over Printed Name/DateRemarks: _________________________________ ___________________________________

Applicants interested to participate in government projects should accomplish Form. No. 601 (Application for Registration and Classification of Government Projects) and file the same together with the PCAB Application Form.

Not for sale . May be reproduced for additional sheets

http://www.dti.gov.ph/

Revised 11/16/07


PCAB Form No. 101a

In behalf of ____________________________________________________________,(Name of Firm)

I hereby request that its application for Contractor's License be approved.

I hereby certify to the completeness of the information/documents contained in this application appertaining to the category/classification the company is applying for and that they are true and correct.

I am fully aware that:

1. all documents submitted in support of this application are subject to verification before PCAB action;

2. any discovered misrepresentation of information and/or manifestations of fraud on the application documents submitted by my firm applicant or its Authorized Representative/Agent/Liaison Officer shall be subjected to investigation which may result to the disapproval of my application, denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized Managing Officer; and

3. unconfirmed information/documents submitted to support my firm's qualifications will be excluded for categorization/classification purposes.

4. the evaluation of my application's qualification shall be solely based on the documents submitted at the time the application was filed/accepted by PCAB.

_______________________________ Authorized Managing Officer

(Signature over Printed Name)

Republic of the Philippines)______________________)S.S.

SUBSCRIBED AND SWORN TO before me this ________ day of ___________________ 20____ at ______________________; affiant exhibited to me his Community Tax Certificate No. _______________ issued at __________________ on _________________ 20 ___.

DOC. NO. _______________;PAGE NO._______________; BOOK NO._______________; __________________________

NOTARY PUBLIC (Until December 31, _______)

Not for sale. May be reproduced for additional sheets

PCAB Form No. 102

GENERAL INFORMATION

A. CONTRACTOR’S IDENTIFICATIONName of Firm:

Office Address: Tel./Fax No.:

If Provincial based, contact address in Manila, if any: Tel./Fax No.:

Website: E-mail Address:

Type of Organization (Please Check):.

[ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Joint Venture

SEC/BTRCP Registration No.: Date of Registration: SEC/BTRCP Expiry Date:

SSS Employer’s I.D.No.: Tax Identification No.:

CATEGORYAPPLIED FOR

______________

CLASSIFICATION/S

APPLIED FOR: Principal Classification: Other Classification/s :

B. OWNERS/STOCKHOLDERS/OFFICERS* (For Corporation, Partnership and Joint Venture)

Name Position NationalityCapital

SubscriptionPaid-Up Capital

C. DIRECTORS / OFFICERS

Name Position NationalityTax Identification No. for

Filipinos/ Passport No. for Foreigners

CERTIFIED CORRECT BY:

____________________________________ Authorized Managing Officer

(Signature over Printed Name)Not for sale . May be reproduced for additional sheets

PCAB Form No. 103

Republic of the Philippines )Province of ______________ )Municipality of ___________ ) S.S.

AMO AFFIDAVIT

I, __________________________________________________________________________________________, LAST NAME FIRST NAME COMPLETE MIDDLE NAME

Filipino, of legal age, born on ____________________________________________________________ single/married to ________________________________________________________________________________________________

LAST NAME FIRST NAME COMPLETE MAIDEN NAME and residing at __________________________________________________________________________ having duly sworn in accordance with law depose and say:

1. That I am the Authorized Managing Officer (AMO) of ________________________________________ empowered to render general management and administrative decisions.

2. That I possess the following educational qualifications:

NAME OF SCHOOL ADDRESS DEGREE EARNEDINCLUSIVE DATESOF ENROLLMENT

3. That I possess at least two (2) years of experience in the construction industry as follows (Sec. 20, R.A. 4566):

POSITIONCOMPANY/

NATURE OF BUSINESS ADDRESS JOB DESCRIPTIONDATES OF

EMPLOYMENT

(use additional sheet if necessary)

4. That I possess knowledge of the building, safety, health , & lien laws of the Republic of the Philippines & the rudimentary administrative principles of construction contracting from my work experiences in item 3 above and from the following training/seminars (Sec. 20, RA 4566):

TRAINING/SEMINAR CONDUCTED BY ADDRESSINCLUSIVE DATES

OF TRAINING

5. That I am not involved in any construction malperformance suggestive of negligence, incompetence or malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other person (Rule 4, Section 4.2)

6. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude (Rule 4, Section 4.2)

7. That I am fully aware that my failure to notify PCAB of my disassociation with my present employer shall cause my disqualification to be an Authorized Managing Officer, a Sustaining Technical Employee or a license applicant with PCAB (For corporations and partnerships only)

8. That I authorize the PCAB to verify and investigate any or all information in this instrument from whatever sources PCAB may consider appropriate;

9. That I certify under pain of perjury that all information on this affidavit are true and correct.

FURTHER AFFIANT SAYETH NAUGHT._________________________________

Affiant

SUBSCRIBED and sworn to before me this _____ day of _________________, 200 ___ affiant exhibited his/her Community Tax Certificate No. __________ issued at _____________________ on ________________.

Doc. No. __________;Page No. __________;Book No. __________; Notary PublicSeries of 200 __. Until December 200__

Passport sizePicture of

AMO


PCAB Form No. 104

For Corporations Only

AMO NOMINATION

I ____________________________________________________, Filipino, of legal age, single/married and residing at -____________________________________________________________ do hereby certify, in my capacity as the duly elected and incumbent Board Secretary of __________________________________________________________________________,

(Name of Firm)that during the regular board/partners' meeting held on ___________________ wherein a quorum was present, the following resolution was unanimously approved, to wit:

"R E S O L V E as it is hereby resolved that

_________________________________________________________________, (Surname, First Name, Middle Name)

a senior executive who has been granted the power to render general management and administrative decision, be appointed as the firm's authorized sole management representative to act on all matters concerning the requirements of the PCAB and implementation of R.A. 4566 as amended by P.D. 1746."

In WITNESS WHEREOF, I have hereunto affixed my hand this ______________ day of ___________________ 200___, in ______________________________, Philippines.

_________________________________ Board Secretary (Signature Over Printed Name)

SUBSCRIBED and sworn to before me this ________ day of ______________________________________ at __________________________________________________, affiant exhibited to me his/her Community Tax Certificate. No. ____________ issued on _________________________ at ______________________________________________.

Doc. No. __________Page No. __________Book No. __________Series of 200 __. NOTARY PUBLIC

Until December 200 ____

Revised 10/01/2007


PCAB Form No. 105

THE MANAGER___________________________________________________________________________________________________

Subject: Account # _______________________

Sir:

Please provide the Philippine Contractors Accreditation Board (PCAB), a government agency under the Department of Trade and Industry, any information they need regarding the subject account with your bank.

I am applying for a contractor's license from PCAB and part of their evaluation process is the verification of bank deposits and other assets of an applicant.

This will serve as your authorization to release any information that may be requested by PCAB regarding the above subject account.

Thank you.

Very truly yours,

___________________________________ Signature over Printed Name

__________________________________

Company Name

___________________________________ Date

Note: To be submitted in two (2) copies.

Revised 10/01/2007


PCAB Form No. 105a

AUTHORIZATION

The Philippine Contractors Accreditation Board (PCAB) is hereby authorized to verify and secure information and/or copies of documents submitted by or in the name of the firm to any or all of the following agencies relative to its application filed with the PCAB:

1. Bureau of Internal Revenue

2. Securities and Exchange Commission

3. Land Registration Authority

4. Land Transportation Office

5. Social Security System

Name of Applicant Firm

_____________________________________

By:

_____________________________________ Signature over Printed Name of Proprietor

or Authorized Managing Officer

Date: _________________________________

Revised 10/01/2007


PCAB Form No. 106a

A. LIST OF LAND, BUILDING AND OTHER IMPROVEMENTS OWNED BY AND REGISTERED IN THE NAME OF THE COMPANY AS OF THE BALANCE SHEET DATE

COMPLETE DESCRIPTION

(Type of land/building and area)

TCT/CCTNUMBER

LOCATION(St. #, Barangay,

Municipality/ City, Province)

ACQUISITIONCOST

ACQUISITIONDATE

Please reproduce if additional sheets are needed. Revised 10/01/2007

_________________________________________ Signature over Printed Name of AMO

_________________________________________Company Name

_________________________________________ PCAB License No. (If applicable)

________________________________________ Date Signed

CFY ___________________

Type of Application: (Pls. check)-

New Upgrading Renewal Others, pls. specify _______________________


PCAB Form No. 106b

B. LIST OF DELIVERY AND TRANSPORTATION EQUIPMENT OWNED BY AND REGISTERED IN THE NAME OF THE COMPANY ASOF THE BALANCE SHEET DATE


A C Q U I S I T I O N BOOK VALUE

Plate No.

Chassis No.

Engine No.

M.V. File No.

CR No. Date Cost

P P

T O T A L P P

LIST OF MACHINERIES/PLANTS AND OTHER CONSTRUCTION EQUIPMENT OWNED BY THE COMPANY AS OF THE BALANCE SHEET DATE


SERIAL NO.A C Q U I S I T I O N BOOK

VALUE Date Cost

P P

T O T A L P P Please reproduce if additional sheets are needed. Revised 10/01/2007

_________________________________________Signature over Printed Name of AMO

_________________________________________Company Name

_________________________________________PCAB License No. (If applicable)

________________________________________Date Signed

CFY _________________Type of Application: (Pls. check)

New Upgrading Renewal Others, pls. Specify __________________________


PCAB Form No. 106c

LIST OF NOMINATED SUSTAINING TECHNICAL EMPLOYEES OF THE COMPANY

NAMEPRC REGISTRATION

Date Employed

Position in the Firm

Number Date Profession

Please reproduce if additional sheets are needed. Revised 10/01/2007

_______________________________________Signature over Printed Name of AMO

_______________________________________Company Name

_______________________________________PCAB License No. (If applicable)

______________________________________Date Signed

CFY __________________

Type of Application: (Pls. check)

New Upgrading Renewal Others, pls. Specify __________________________


PCAB Form No. 107

SCHEDULE OF RECEIVABLES

To be accomplished if the applicant's receivable accounts (accounts/contracts & other receivable) exceed 20% of the total networth/equity as of the latest audited balance sheet submitted in support of its application.

TYPES AMOUNT AGE NAME/ADDRESS OF DEBTOR/CLIENTS

Notes: * All receivable accounts must be substantiated by confirmation of debtors/clients Please use additional sheets if necessary

Certified Correct by:

_______________________________ ___________________________Printed Name and Signature of External Auditor Printed Name and Signature of AMO

SCHEDULE OF INVENTORIES

To be accomplished if the applicant's inventory accounts exceed 20% of the total networth/equity as of the latest audited balance sheet submitted in support of its application.

Types Amount Age/Date Acquired

Intended Use or Purpose for

StoringPhysical

ConditionPlace of Storage

Please use additional sheets if necessary Certified Correct by:

_______________________________ ___________________________Printed Name and Signature of External Auditor Printed Name and Signature of AMO

* The above schedules should be certified by the firm’s external auditor and signed by the authorized managing officer.l


PCAB Form No. 108

Republic of the Philippines )Province of _____________ )Municipality of ___________) S.S.

STE AFFIDAVIT I,____________________________________________________________________, Filipino, of legal age, LAST NAME FIRST NAME COMPLETE MIDDLE NAME

born on single/married to __________________________________________and M M / D D/ Y Y Y Y residing at ____________________________________________________________________ having duly sworn in accordance with law depose and say:

1. That I am a duly licensed __________________________ and holder of PRC registration no. ___________ (PROFESSION)

valid up to _______________ (copy of my PRC is attached at the back hereof);

2. That I hold a Bachelor's Degree in _________________________________________________________ at ______________________________________________________ given on _____________________; (NAME OF SCHOOL)

3. That my Tax Identification Number (TIN) and Social Security No. are - - and - - respectively;

4. That I am not presently employed in any government office or government owned/controlled corporation, nor a full time instructor, nor working abroad;

5. That I am employed by _________________________________________________________________ (NAME OF FIRM)

on regular and full-time basis with the position of _________________________________and presently being nominated as Sustaining Technical Employee for CFY _____________;

6. That I am not a holder of a contractor's license;

7. That I am not involved in any construction malperformance suggestive of negligence, incompetence or malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other person;

8. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude;

9. That I am fully aware that my failure to notify the PCAB of my disassociation with my present employer shall cause my disqualification to be sustaining technical employee or authorized managing officer or a license applicant with PCAB;

10. That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB may consider appropriate;

11. That I am executing this affidavit to attest to the truth of the foregoing.

FURTHER AFFIANT SAYETH NAUGHT.

_________________________________ Affiant

SUBSCRIBED and sworn to before me this _____ day of ___________________, 200___ affiant exhibited his/her Community Tax Certificate No. _____________ issued at ___________________ on ______________.

Doc. No. __________;Page No. __________;Book No. __________; Notary PublicSeries of 200 _______. Until December 200 ___

CFY ___________________

Type of Application: (Pls. check)

New Upgrading Renewal Others, pls. specify _____________________

Revised 10/01/2007

Passport sizePicture of STE


INSTRUCTIONS ON FILLING UP PCAB FORM NO. 108

QUALIFICATION REQUIREMENTS OF SUSTAINING TECHNICAL EMPLOYEE

1. A technology professional, such as engineer or architect, duly licensed by the Professional Regulation Commission.

2. Holder of a Professional I.D. valid for current year.

3. Possesses at least three (3) years of experience in implementation of construction to which he is to be nominated

4. A full-time employee of the nominating contractor, not associated professionally or by employment with any other party, particularly a party engaged in construction or construction-related activities

5. Have none of the following disqualifications:

a) Involvement, in any capacity, in any construction malperformance of grave consequence, suggestive of his negligence, incompetence and/or malpractice;

b) Involvement, by himself or in collaboration with any other person or firm, in any act or omission liable for disciplinary action of which he is or the other person or firm was found guilty by the Board;

c) Conviction by a court of competent jurisdiction of any offense involving moral turpitude; and

d) If formerly a Sustaining Technical Employee or an Authorized Managing Officer of any construction firm but disassociated therefrom, failure to notify the Board of his disassociation in accordance with paragraph 5 and 6 of the Affidavit of Undertaking.

6. Not a holder of a Contractor’s License.

If you meet the above requirements, kindly accomplish this affidavit. Erasure must be properly initialled.

All statements are subject to verification and any false statement or willful misrepresentation of a material fact in obtaining a license shall be grounds for disapproval of this application.

PASTE

PROF. I.D. CARD

VALID FOR

CURRENT YEAR

(Front)(xerox copy)

PASTE

PROF. I.D. CARD

VALID FOR

CURRENT YEAR

(Back)(xerox copy)

This is to certify that I have verified with PRC the abovestated professional eligibility/registration of the Sustaining Technical Employee. Affiant herein and found the same to be true and correct.

__________________________________________ Signature over Printed Name of the AMO

Date: _______________________


PCAB Form No. 109Republic of the Philippines )Province of _____________ )Municipality of ___________) S.S.

AFFIDAVIT OF STE CONSTRUCTION EXPERIENCEI, _________________________________, single/married, Filipino, of legal age, with postal address at

________________________________________________, having been duly sworn in accordance with law depose and say that the projects enumerated below constitute my full & complete construction experience.

NAME and COMPLETE ADDRESS of EMPLOYER/

NAME & LOCATION of PROJECTS UNDERTAKEN

WorkClassification(GE, GB, SP)

Nature/Scope of Work Assignment

(Proj. Engr.)

PROJECT DURATION(mm/dd/yy)

From To

That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCABmay consider appropriate;

That I am executing this affidavit to attest to the truth of the foregoing.

FURTHER AFFIANT SAYETH NAUGHT._________________________________

Affiant

SUBSCRIBED and sworn to before me this _____ day of _________________, 200__ affiant exhibited his/her Community Tax Certificate No. ______________ issued at ____________________ on ____________________.

Doc. No. __________;Page No. __________;Book No. __________; Notary PublicSeries of 200 _______. Until December 200 ___

CFY ___________________ Company Name ____________________________

Type of Application: (Pls. check) PCAB License No. __________________________

New Upgrading Renewal Others, pls. specify ___________________________ Revised 10/01/2007


PCAB Form No. 110

SUSTAINING TECHNICAL EMPLOYEE (STE) PERSONAL APPEARANCE FORM(To be accomplished fully by the STE)

Name: ______________________________________________ Sex: __________________Address: ____________________________________________________________________Profession: __________________________________ PRC Reg. :_____________Nominating Firm: ____________________________________________________________Contractor's License No.: ______________________

I hereby confirm the following:

1. The veracity of the information reflected on the STE Affidavit and Affidavit of Construction Experience (PCAB Form Nos. 107 & 108, copies attached) that I executed in favor of the above firm;

2. That I am fully aware that my failure to notify the PCAB of my disassociation from the above-stated nominating firm and any misrepresentation in the attached forms shall cause my disqualification as sustaining technical employee, or authorized managing officer, or a licensee applicant with PCAB per Board Resolution No. 401, Series of 2001.

3. That I have been previously connected with the following companies:

Previous EmployersDate of

EmploymentDate of

Resignation Position

4. Other Remarks:

___________________________________________________________________________

___________________________________________________________________________

______________________________ STE's Signature

Date Signed: _______________________

Identification Documents Presented:

1. PRC ID No. ____________________

valid until ______________________

2. ______________________________

Personal Appearance and Presentationof Two (2) Identification Documentsattested by PCAB designated staff orDTI Regional/Provincial Staff

_______________________________Signature over Printed Name/Position

DTI Office Address: ______________________________________________Date: ____________________________


PCAB Form 111-A(For sole proprietorship)

Republic of the Philippines) s.s.______________________)

AFFIDAVIT

I, _______________________________, of legal age, Filipino, married/single with postal address at ____________________________________, after having been sworn to in accordance with law, hereby depose and say:

1. That I am the Proprietor/Authorized Managing Officer (AMO) of __________________________________________________________;

(Name of Firm)

2. That I appoint ____________________________, whose picture and signature appear below, to transact business with PCAB; i.e, present for pre-screening my application for contractor’s license or any application related thereto, file/follow-up, submit documents, receive notices/license in connection with the said application and the like.

______________________________ (Signature over Printed Name)

______________________________

__________ ______________________________ HOME /MAILING ADDRESS

3. That I am aware that I am responsible/liable for any or all acts/representation made by my representative in connection with the functions stated herein.

4. That I undertake to notify PCAB in the event that this appointment is modified, amended or revoked.

_______________________________________ AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ____________, 20___, affiant exhibited his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________.

Doc No. __________Page No. _________Book No. _________Series of _________

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)


Representative

Notary PublicUntil December 200 ___


PCAB Form 111-B (For corporation.,partnership,cooperative joint venture or consortium)

Republic of the Philippines) s.s.______________________)

AFFIDAVIT

I, _______________________________, of legal age, Filipino, married/single with postal address at ____________________________________, after having been sworn to in accordance with law, hereby depose and say:

1. That I am the Authorized Managing Officer (AMO) of __________ ________________________________________; (Name of firm)

2. That the abovestated firm had duly appointed ____________________________, whose picture and signature appear below, to transact business with PCAB; i.e, present for pre-screening its application for contractor’s license or any application related thereto, file/follow-up, submit documents, receive notices/license in connection with the said application and the like.

______________________________ (Signature over Printed Name)

______________________________

______________________________ HOME /MAILING ADDRESS

3. That we are aware that we are responsible/liable for any or all acts/representation made by the above representative in connection with the functions stated herein.

4. That the firm undertakes to notify PCAB in the event that this appointment is modified, amended or revoked.________________________

AFFIANT

SUBSCRIBED and sworn to before me this ______ day of ______________, 20__ affiant exhibited his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________.

Doc No. __________Page No. _________Book No. _________Series of _________

(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)


Representative

Notary PublicUntil December 200 ___


ARC Form 601

Application for REGISTRATION AND CLASSIFICATIONOF CONTRACTOR FOR GOVERNMENT INFRASTRUCTURE PROJECTS

with the Philippine Contractors Accreditation Board

In behalf of ____________________________________________________________(Name of Firm)

a contractor duly licensed with the Philippine Contractors Accreditation Board. I hereby request for registration pursuant to the implementing Rules and Regulations of PD 1594, as amended.

I hereby certify that the information and documents contained in this application are true and correct of my own personal knowledge. I am fully aware that I shall be held personally liable for any misrepresentation that may be found herein.

____________________________________ Authorized Managing Officer


Republic of the Philippines}_______________________} s.s.

SUBSCRIBED AND SWORN to before me this _______ day of ___________________ 200 ___ at ___________________________________ affiant exhibited to me his Community Tax Certificate No. ______________ issued at _________________________ on ________________ 200 ____.

Doc. No. :Page No. :Book No. : NOTARY PUBLICSeries of : Until December 31, 200 ___

The following documents and information are hereby submitted in support of this registration application:

]

Checklist of Registration Application:

1. General Information (PCAB Form No. 602). 2. List of Single Largest Contract completed by the contractor of each Project Kind

being applied for (PCAB Form No. 603). 3. Copy of Contract Agreement listed in PCAB Form No. 603 of each Project Kind

being applied for duly authenticated by the tendering agency or project owner or in case of subcontract by the prime/main contractor.

4. Copy of Certificate of Acceptance/Completion from Tendering Agency/Project Owner of each Contract Agreement submitted duly authenticated by the tendering agency or project owner or in case of subcontract by the prime/main contractor.

5.Copy of Certificate of Creditable Income Tax Withheld (Form 1743.1/1743.750/2307),

stamped-received by BIR for each private contracts and sub-contracts. NOTE: Application for registration and supporting documents must be submitted in a folder and

signed on each and every page by the Proprietor/Authorized Managing Officer.

Do not fill, for PCAB use only:

Total no. of pages submitted ________ Checklisted by: ___________________________________ (Signature over Printed Name)Remarks: __________________________________________________ _________________

__________________________________________________ (Date)(Revised 032601_GSD)

Note: Only citizens or entities with at least 75% Filipino equity may apply


PCAB Form No. 602

GENERAL INFORMATION SHEETContractors ParticularsFIRM NAME:OFFICE ADDRESS: TEL, NO.:

TYPE OF ORGANIZATION: Corporation Partnership Sole Proprietorship

EQUITY: Filipino: % Foreign: %

License Particulars

Contractor’s License No.: Date Issued: Last Renewal: CFY _____ - _____

Principal Classifications: Present Category:

Other Classification(s): _____________________________________________________________________

_____________________________________________________________________

Type of application for PCAB License amendment, if any: Ref. No.:

Government Registration Particulars

PRESENT REGISTRATION VALIDITY PERIOD, if applicable: from _______________ to ________________

APPLICATION APPLIED FOR: New Registration Re-registration Upgrading Additional Project Kind

SIZE RANGEPlease indicate if:Small A, Small B,

Medium A, Medium B,Large A, Large B

KIND OF PROJECT(Please check)

__________________________________________________________________________________________

GENERAL ENGINEERING GE-1 Road, Highway pavement, Railways, Airport horizontal structures, & Bridges GE-2 Irrigation and Flood Control GE-3 Dam, Reservoir, and Tunneling GE-4 Water Supply GE-5 Port, Harbor, and Offshore Engineering

________________________________________________________________________

GENERAL BUILDING GB-1 Building and Industrial Plant GB-2 Sewerage and Sewage Treatment/Disposal Plant GB-3 Water Treatment Plant and System GB-4 Park, Playground, and Recreational Work

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SPECIALTY SP-1 Foundation Work SP-2 Structural Steel Work SP-3 Concrete Pre-casting and Pre-stressing SP-4 Plumbing and Sanitary Work SP-5 Electrical Work SP-6 Mechanical Work SP-7 Air-conditioning and Refrigeration Work SP-8 Elevator and Escalator Work SP-9 Fire Protection Work SP-10 Waterproofing Work SP-11 Painting Work SP-12 Well Drilling Work SP-13 Navigational Facilities SP-14 Communications Facilities

CERTIFIED CORRECT BY:

_______________________________Authorized Managing Officer/ Proprietor



PCAB Form No. 603

TRACK RECORD FORM (Only complete form & supporting documents will be considered)

_________________________________________________________________________ __________________ Name of Firm License No.

SINGLE LARGEST CONTRACTS COMPLETED For ________________________________________Project Kind applied for (e.g. Road, Building etc.)

I. CONTRACT

Project Title:________________________________________________________

_______________________________________________________ ________________________________________________________

Project Location:

________________________________________________________

Project Owner:

________________________________________________________

Date of Contract:___________________ Amount of Contract: P _________________

Name of Main Contractor or Joint Venture, if any: _________________________________

Percent (%) share of the applicant in the contract: ____________ %

II. ACCEPTANCEDate of Document________________________ Date Accepted: __________________

Name of Signatory: _________________________ Position: _______________________

III. WITHHOLDING TAX (for subcontract and non-government contract)

Withholding agent: ________________________________________________________

Name of the withholding agent's signatory: _____________________________________

Received and Stamped by:

BIR BANK

RDO No._______________________ Name: ________________________Address:_______________________ Address: ______________________

_______________________________ _____________________________ Date: __________________________ Date: _________________________

INSTRUCTIONS: 1.Attach at the back of this form clear & legible copies of the following documents:a) Contract agreement duly authenticated by the tendering agency/project owner/ prime contractor in

case of subcontract.b) Letter or certificate of acceptance duly authenticated by the tendering agency/ project owner/prime

contractor in case of subcontract.c) Certificate of creditable income tax withheld of source (BIR Form 1743.1, 1743.750 or 2307) duly

stamped-received by the BIR or Bank Collecting Agent for subcontracts & non-government or private contracts)

2.Submit only one track record for each project kind.

_______________________________________________Authorized Managing Officer/Proprietor(Signature over Printed Name)


dti application for contractor's license

Documents

amo pcab form

agencies pcab form

amo affidavit pcab form

ste affidavits pcab

general information

depository bank pcab

pertinent btrcp form

certified true copy