PCAB Form No PCAB Form No 101 APPLICATION FOR CONTRACTOR S LICENSE with by ppe16615

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									                                                              PCAB Form No. 101
                                       APPLICATION FOR CONTRACTOR'S LICENSE
                              with 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; and
                   b. 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 including
           supporting 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/Date
     Remarks: _________________________________ ___________________________________
  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.
  Revised 11/16/07
                                                                                  Not for sale . May be reproduced for additional sheets
                                                                                          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 IDENTIFICATION
 Name 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.:

  CATEGORY                                               CLASSIFICATION/S
 APPLIED FOR         APPLIED FOR:         Principal Classification:
                                          Other Classification/s :
______________

B. OWNERS/STOCKHOLDERS/OFFICERS* (For Corporation, Partnership and Joint Venture)
                                                                      Capital     Paid-Up
            Name                 Position          Nationality Subscription       Capital




C. DIRECTORS / OFFICERS

                                                                                      Tax Identification No. for
                  Name                             Position           Nationality     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
                                                                                                    Passport size
                                                                                                     Picture of
                                                                                                       AMO
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:
                                                                                                        INCLUSIVE DATES
        NAME OF SCHOOL                         ADDRESS                       DEGREE EARNED              OF ENROLLMENT




3. That I possess at least two (2) years of experience in the construction industry as follows (Sec. 20, R.A. 4566):
                            COMPANY/                                                                           DATES OF
        POSITION        NATURE OF BUSINESS            ADDRESS                   JOB DESCRIPTION              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):

                                                                                                        INCLUSIVE DATES
           TRAINING/SEMINAR                   CONDUCTED BY                      ADDRESS                   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 Public
Series of 200 __.                                                            Until December 200__
 Not for sale . May be reproduced for additional sheets
                                                                                              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




      Not for sale . May be reproduced for additional sheets
                                                                                         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




Not for sale . May be reproduced for additional sheets
                                                                                         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: _________________________________




 Not for sale . May be reproduced for additional sheets
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                                  TCT/CCT            LOCATION                 ACQUISITION   ACQUISITION
            DESCRIPTION                                 NUMBER          (St. #, Barangay,              COST          DATE
         (Type of land/building                                     Municipality/ City, Province)
               and area)




    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
                 _______________________



            Not for sale . May be reproduced for additional sheets
                                                                                                   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

                    COMPLETE DESCRIPTION                                ACQUISITION                BOOK
                                                                                                     VALUE
      Plate        Chassis        Engine        M.V. File     CR No.    Date            Cost
       No.           No.           No.            No.

                                                                                        P          P




 TOTAL                                                                                  P          P

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

              COMPLETE                                                     ACQUISITION                 BOOK
                                                SERIAL NO.
             DESCRIPTION                                                 Date               Cost       VALUE

                                                                                        P          P




 TOTAL                                                                                  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
              __________________________
             Not for sale . May be reproduced for additional sheets
                                                                                             PCAB Form No. 106c




           LIST OF NOMINATED SUSTAINING TECHNICAL EMPLOYEES OF THE COMPANY

                                                            PRC REGISTRATION
                                                                                         Date       Position
          NAME                                                                         Employed   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
          __________________________

           Not for sale . May be reproduced for additional sheets
                                                                                                                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.
                                                                    Intended Use or
              Types                     Amount       Age/Date                               Physical         Place of Storage
                                                                      Purpose for
                                                     Acquired           Storing             Condition




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


   Not for sale . May be reproduced for additional sheets
PCAB Form No. 108



                                                                                                   Passport size
                                                                                                  Picture of STE
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 Public
Series of 200 _______.                                                     Until December 200 ___


CFY ___________________
Type of Application: (Pls. check)
          New
          Upgrading
          Renewal
          Others, pls. specify
           _____________________
                               Revised 10/01/2007


      Not for sale . May be reproduced for additional sheets
                                     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                                                 PASTE

                        PROF. I.D. CARD                                       PROF. I.D. CARD

                           VALID FOR                                             VALID FOR

                        CURRENT YEAR                                           CURRENT YEAR

                                                                                    (Back)
                              (Front)                                            (xerox copy)
                           (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: _______________________




                    Not for sale . May be reproduced for additional sheets
                                                                                                            PCAB Form No. 109
Republic of the Philippines    )
Province of _____________      )
Municipality of ___________) S.S.

                            AFFIDAVIT OF STE CONSTRUCTION EXPERIENCE
           I, _________________________________, 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                                     Work            Nature/Scope of              PROJECT
      COMPLETE ADDRESS of EMPLOYER/                       Classification      Work Assignment             DURATION
  NAME & LOCATION of PROJECTS UNDERTAKEN                  (GE, GB, SP)          (Proj. Engr.)             (mm/dd/yy)
                                                                                                From                   To




That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB
may 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 Public
 Series 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

      Not for sale . May be reproduced for additional sheets
                                                                                           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:

                                                                Date of         Date of
                       Previous Employers                     Employment      Resignation          Position




4. Other Remarks:
___________________________________________________________________________

___________________________________________________________________________


                                                            ______________________________
                                                                         STE's Signature

                                                          Date Signed: _______________________


                                                             Identification Documents Presented:
                                                              1. PRC ID No. ____________________
                                                                 valid until ______________________

                                                              2. ______________________________

Personal Appearance and Presentation
of Two (2) Identification Documents
attested by PCAB designated staff or
DTI Regional/Provincial Staff


_______________________________
Signature over Printed Name/Position

DTI Office Address: ______________________________________________
Date: ____________________________
Not for sale . May be reproduced for additional sheets
                                                                                 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.




                          Passport size                          ______________________________
                           Picture of                               (Signature over Printed Name)
                         Representative
                                                                 ______________________________

                           __________                            ______________________________
                                                                          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. __________                                                Notary Public
Page No. _________                                                Until December 200 ___
Book No. _________
Series of _________


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




                 Not for sale . May be reproduced for additional sheets
                                                                                                  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.


                                                                ______________________________
                          Passport size                            (Signature over Printed Name)
                           Picture of
                         Representative
                                                                ______________________________

                                                                ______________________________
                                                                       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. __________                                                Notary Public
Page No. _________                                                Until December 200 ___
Book No. _________
Series of _________

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




              Not for sale . May be reproduced for additional sheets
Not for sale . May be reproduced for additional sheets
 ARC Form 601

                              Application for REGISTRATION AND CLASSIFICATION
                        OF 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
                                                                      (Signature over Printed Name)

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 PUBLIC
Series 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


                  Not for sale . May be reproduced for additional sheets
                                                          PCAB Form No. 602

                                               GENERAL INFORMATION SHEET
Contractors Particulars
FIRM 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 RANGE
   Please indicate if:
  Small A, Small B,                                                  KIND OF PROJECT
 Medium A, Medium B,                                                         (Please check)
   Large A, Large B
__________________           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
                                                                                (Signature over Printed Name)



   Not for sale . May be reproduced for additional sheets
  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. ACCEPTANCE
             Date 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)




         Not for sale . May be reproduced for additional sheets

								
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