Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSEC NO. R_______________

FIRE SAFETY EVALUATION CLEARANCE

________________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008 the application for FIRE SAFETY EVALUATION CLEARANCE of _____________________________________________________________ (Name of Building/Structure/Facility) ______________________________________________________________________________________________________ to be constructed / renovated / altered / modified / change of occupancy located at ______________________________________________________________________________________________________

(Address)

owned by _______________________________________________________is hereby GRANTED after the building plans and (Name of Owner/Representative) other documents conform to the fire safety and life safety requirements of the Fire Code of the Philippines of 2008 and its IRR and that the recommendations in the Fire Safety Checklist (FSC) will be adopted. This clearance is being issued for ___________________________________________________________________ ______________________________________________________________________________________________________ Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the building liable to the penalties provided for by the said Fire code.

Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Clearance is accompanied by Fire safety Checklist and does not take the place of any license required by

law and is not transferable. Any change or alteration in the design and specification during construction shall require a

new clearance” PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG

MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

DISTRIBUTION: Light Blue-Green (Applicant/Owner’s copy) Pink (OBO’s copy) Blue (BFP’s copy)

ORIGINAL

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSEC NO. R_______________

FIRE SAFETY EVALUATION CLEARANCE

_______________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008 the application for FIRE SAFETY EVALUATION CLEARANCE of ________________________________________________________________ (Name of Building/Structure/Facility)

______________________________________________________________________________________________________ to be constructed / renovated / altered / modified / change of occupancy located at ______________________________________________________________________________________________________

(Address)

owned by _____________________________________________________is hereby GRANTED after the building plans and (Name of Owner/Representative) other documents conform to the fire safety and life safety requirements of the Fire Code of the Philippines of 2008 and its IRR and that the recommendations in the Fire Safety Checklist (FSC) will be adopted.. This clearance is being issued for ___________________________________________________________________ ______________________________________________________________________________________________________ Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the building liable to the penalties provided for by the said Fire code.

Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Clearance is accompanied by Fire safety Checklist and does not take the place of any license required by law and is not transferable. Any change or alteration in the design and specification during construction shall require a

new clearance” PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG

MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

DISTRIBUTION: Light Blue-Green (Applicant/Owner’s copy) Pink (OBO’s copy) Blue (BFP’s copy)

DUPLICATE

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSEC NO. R_______________

FIRE SAFETY EVALUATION CLEARANCE

_______________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008 the application for FIRE SAFETY EVALUATION CLEARANCE of ________________________________________________________________ (Name of Building/Structure/Facility)

______________________________________________________________________________________________________ to be constructed / renovated / altered / modified / change of occupancy located at ______________________________________________________________________________________________________

(Address)

owned by _______________________________________________________is hereby GRANTED after the building plans and (Name of Owner/Representative) other documents conform to the fire safety and life safety requirements of the Fire Code of the Philippines of 2008 and its IRR and that the recommendations in the Fire Safety Checklist (FSC) will be adopted. This clearance is being issued for ___________________________________________________________________ ______________________________________________________________________________________________________ Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the building liable to the penalties provided for by the said Fire code.

Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Clearance is accompanied by Fire safety Checklist and does not take the place of any license required by law and is not transferable. Any change or alteration in the design and specification during construction shall require a

new clearance” PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG

MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

DISTRIBUTION: Light Blue-Green (Applicant/Owner’s copy) Pink (OBO’s copy) Blue (BFP’s copy)

TRIPLICATE

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSIC NO. R_______________

FIRE SAFETY INSPECTION CERTIFICATE (FOR BUSINESS PERMIT)

___________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008, the application for

FIRE SAFETY INSPECTION CERTIFICATE of ____________________________________________________________________ (Name of Establishment) __________________________________________________________________________________________________________

owned and managed by ____________________________________________________________________ with postal address at (Name of Owner/Representative) __________________________________________________________________________________________________________ (Address) is hereby GRANTED after said building structure or facility has been duly inspected with the findings that it has fully complied with the fire safety and protection requirements of the Fire Code of the Philippines of 2008 and its Implementing Rules and Regulations.

This certificate is being issued for _______________________________________________________________________________________

__________________________________________________________________________________________

This certification is valid until________________________

Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the building liable to the penalties provided for by the said Fire code. Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Certificate does not take the place of any license required by law and is not transferable. Any change in the use

of occupancy of the premises shall require a new certificate.”

THIS CERTIFICATE SHALL BE POSTED CONSPICUOUSLY PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG

MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN” DISTRIBUTION: Light Blue-Green (Applicant/Owner’s copy) Pink (BPLO’s copy) Blue (BFP copy)

ORIGINAL

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSIC NO. R_______________

FIRE SAFETY INSPECTION CERTIFICATE

(FOR BUSINESS PERMIT)

_______________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008, the application for

FIRE SAFETY INSPECTION CERTIFICATE of ____________________________________________________________________ (Name of Establishment) __________________________________________________________________________________________________________

owned and managed by ____________________________________________________________________ with postal address at (Name of Owner/Representative) __________________________________________________________________________________________________________ (Address) is hereby GRANTED after said building structure or facility has been duly inspected with the findings that it has fully complied with the fire safety and protection requirements of the Fire Code of the Philippines of 2008 and its Implementing Rules and Regulations.

This certificate is being issued for _____________________________________________________________________ __________________________________________________________________________________________________________

This certification is valid until ________________________________

Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the

building liable to the penalties provided for by the said Fire code. Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Certificate does not take the place of any license required by law and is not transferable. Any change in the use

of occupancy of the premises shall require a new certificate.”

THIS CERTIFICATE SHALL BE POSTED CONSPICUOUSLY PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG

MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN” DISTRIBUTION: Light Blue-Green (Applicant/Owner’s copy) Pink (BPLO’s copy) Blue (BFP’s copy)

DUPLICATE

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSIC NO. R_______________

FIRE SAFETY INSPECTION CERTIFICATE

(FOR BUSINESS PERMIT)

_______________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008, the application for

FIRE SAFETY INSPECTION CERTIFICATE of ____________________________________________________________________ (Name of Establishment) __________________________________________________________________________________________________________

owned and managed by ____________________________________________________________________ with postal address at (Name of Owner/Representative) __________________________________________________________________________________________________________ (Address) is hereby GRANTED after said building structure or facility has been duly inspected with the findings that it has fully complied with the fire safety and protection requirements of the Fire Code of the Philippines of 2008 and its Implementing Rules and Regulations.

This certificate is being issued for _____________________________________________________________________ __________________________________________________________________________________________________________

This certification is valid until ________________________________

Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the

building liable to the penalties provided for by the said Fire code. Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Certificate does not take the place of any license required by law and is not transferable. Any change in the use of occupancy of the premises shall require a new certificate.”

THIS CERTIFICATE SHALL BE POSTED CONSPICUOUSLY PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG

MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN” DISTRIBUTION: Light Blue-Green (Applicant/Owner’s copy) Pink (BPLO’s copy) Blue (BFP’s copy) TRIPLICATE

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSIC NO. R_______________

FIRE SAFETY INSPECTION CERTIFICATE (FOR OCCUPANCY PERMIT)

__________________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008, the application for FIRE SAFETY INSPECTION CERTIFICATE of ________________________________________________________________ (Name of Establishment) ______________________________________________________________________________________________________

owned and managed by ________________________________________________________________ with postal address at (Name of Owner/Representative) ______________________________________________________________________________________________________ (Address) is hereby GRANTED after said building structure or facility has been duly inspected with the findings that it has fully complied with the fire safety and protection requirements of the Fire Code of the Philippines of 2008 and its Implementing Rules and Regulations. This certificate is being issued for ___________________________________________________________________

____________________________________________________________________________________________________________________________ Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the building liable to the penalties provided for by the said Fire code. Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Certificate does not take the place of any license required by law and is not transferable. Any change in the use of occupancy of the premises shall require a new certificate.”

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

DISTRIBUTION: Light Blue-Green (Applicant/Owner’s Copy)

Pink (OBO’s copy) Blue (BFP’s copy)

ORIGINAL

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSIC NO. R_______________

FIRE SAFETY INSPECTION CERTIFICATE

(FOR OCCUPANCY PERMIT)

_______________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008, the application for FIRE SAFETY INSPECTION CERTIFICATE of ________________________________________________________________ (Name of Establishment) ______________________________________________________________________________________________________

owned and managed by ________________________________________________________________ with postal address at (Name of Owner/Representative) ______________________________________________________________________________________________________ (Address) is hereby GRANTED after said building structure or facility has been duly inspected with the findings that it has fully complied with the fire safety and protection requirements of the Fire Code of the Philippines of 2008 and its Implementing Rules and Regulations. This certificate is being issued for ___________________________________________________________________ ______________________________________________________________________________________________________

Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the building liable to the penalties provided for by the said Fire code. Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Certificate does not take the place of any license required by law and is not transferable. Any change in the use of occupancy of the premises shall require a new certificate.”

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN”

DISTRIBUTION: Light Blue-Green (Applicant/Owner’s Copy) Pink (OBO’s copy) Blue (BFP’s copy)

DUPLICATE

Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION ___________________

______________________ __________________________

______________________________

FSIC NO. R_______________

FIRE SAFETY INSPECTION CERTIFICATE

(FOR OCCUPANCY PERMIT)

_______________________

Date

TO WHOM IT MAY CONCERN:

By virtue of the provisions of RA 9514 otherwise known as the Fire Code of the Philippines of 2008, the application for FIRE SAFETY INSPECTION CERTIFICATE of ________________________________________________________________ (Name of Establishment) ______________________________________________________________________________________________________

owned and managed by ________________________________________________________________ with postal address at (Name of Owner/Representative) ______________________________________________________________________________________________________ (Address) is hereby GRANTED after said building structure or facility has been duly inspected with the findings that it has fully complied with the fire safety and protection requirements of the Fire Code of the Philippines of 2008 and its Implementing Rules and Regulations. This certificate is being issued for ___________________________________________________________________ ______________________________________________________________________________________________________ Violation of Fire Code provisions shall ipso facto cause this certificate null and void, and shall hold the owner of the building liable to the penalties provided for by the said Fire code. Fire Code Fees: Amount Paid: __________________ RECOMMEND APPROVAL: O.R. Number: __________________ Date: _________________________ _____________________________ CHIEF, FSES APPROVED: _____________________________ CITY/MUNICIPAL FIRE MARSHAL

NOTE: “This Certificate does not take the place of any license required by law and is not transferable. Any change in the use of occupancy of the premises shall require a new certificate.”

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”

“FIRE SAFETY IS OUR MAIN CONCERN” DISTRIBUTION:

Light Blue-Green (Applicant/Owner’s Copy) Pink (OBO’s copy) Blue (BFP’s copy)

TRIPLICATE