DOLE-BWC-IP-3
Republic of the Philippines
Department of Labor and Employment
National Capital Region
MAKATI-PASAY FIELD OFFICE
2/F ECC Building, Jupiter Street,
BelAir, Makati City
Registry of Establishment
EIN:
Series of
Application No
1. Name of Establishment
2. Address
Street Barangay/District City
3. Tax Identification Number (TIN):
4. Telephone No. : Fax No. : Email Address:
5. Name of Manager / Owner
6. Nature of Business & Product Manufactured, Service rendered or Merchandise sold:
( Example Manufacturing -- Textile, Construction -- Building, Agriculture -- Production of Livestock, etc; Forestry -
Logging; Services -- Generation and Distribution of Electricity, Commerce - Lumber and Construction Materials;
Wholesale or Retail)
Services
7. Number of Employees
Non-
Resident Below 15- 18-30 Above
Total Filipinos Resident Below 15
Alien 17 yrs yrs 30 yrs.
Alien
Male
Female
Grand Total
8. Name & Address of Labor Union, if any:
BLR Registration No.
9. Technical Information (Please Check / Enumerate)
9a. Machinery, Equipment and Other Devices in use:
Circular saw Machine Drill Press Boiler Pressure Vessel Internal Combustion Engine
Engine Diesel Gasoline Others, Specify
9b. Materials Handling Equipment:
Power Trucks Hand Trucks Conveyors Forklift Cranes Others, Specify
9c. Chemical or Substances Used or Handled:
10.If Branch unit, name of parent establishment:
Location
11.Current Capitalization Total Assets:
12.Photocopy of DTI Certificate of Registration / Business Permit (pls. attach)
FOR RE-REGISTRATION ACCOMPLISH ALSO:
13.Past Application Number Date of Application
14.If Changing Name of Establishment, State Former Name;
15.If Changing Location, Give Past Address:
I hereby certify that the above information is true and correct.
Owner/President
Date Filed : ________________________ Date Approved: ____________________________
Approved by:
LEONIDES P. CASTILLON, JR
DIRECTOR II