FORM NO. 3
Office of the President of the Philippines
MOVIE AND TELEVISION REVIEW AND CLASSIFICATION BOARD
MTRCB Building, No. 18 Timog Avenue, Quezon City
Telefax No. (02) 376-7358; 376-7380
APPLICATION FOR TELEVISION PERMIT TO EXHIBIT
Please check box: / / Sample episode / / PBB episodes / / Full Length / / TV Special / / TV Trailer
/ / Sample plug / / PBB plugs / / TV Plug (Full Length) / / TV Plug (Special)
/ / Live / / Religious / / Replay / / Second Review / / New Version / / No Plug
/ / Imported – Import Permit No. ___________________________ No. of episodes applied _________
1. Title of Film/Program: _______________________________________________________________________
2. No. of Episode/s :__________________________________ No. of Replay/s :__________________________
3. Owner/Producer/Blocktimer/Distributor: _________________________________________________________
4. Address: _________________________________________________________________________________
5. Tel. No/s:________________________________________ Fax: ____________________________________
6. Email Address: ___________________________________ Type of Program: _________________________
7. Date/s of Telecast: _________________________________________________________________________
_________________________________ Time of Telecast: _________________________
8. Length/Running Time: ______________________________ Television Channel/s: ______________________
9. No. of Material/s-Format: ____________________________ Preferred Classification: ____________________
REPUBLIC OF THE PHILIPPINES)
CITY OF _____________________ ) S.S.
I _________________________________________ , of legal age, Filipino and with postal address at
________________________________________________________, after having been duly sworn to in accordance with law,
hereby depose and state, that:
I own the rights to exhibit the aforementioned film/television program;
If the film is approved for exhibition, I shall exhibit only the same version of the film as reviewed and approved by
MTRCB and that I shall use the same film format for public exhibition as presented to the MTRCB for television release and
shall not convert it to other film format without prior written authority therefrom;
I waive any right to question the MTRCB should it subsequently declared that the film /program shown in television is
different from that as reviewed and approved for exhibition, unless I deposit with the MTRCB during the period of film/program
showing the same copy of the film/program submitted for review;
Should the film/program shown in television turns out to be different in any manner from that as reviewed and approved by
the MTRCB due but not limited to insertions, intercalation or additions thereto, I understand that the MTRCB has the authority to
immediately stop the continued showing of the said film/program in any television channel;
I agree to conform to all requirement of review and classification of the aforesaid film/television program as a condition
precedent for the issuance of its Permit to Exhibit, violation of which shall hold me administratively and criminally liable under
Presidential Decree No. 1986 for such violation.
IN WITNESS WHEREOF, I have hereunto affixed my signature below this ___ day of ___________ in ______________.
Affiant (Signature over Printed Name and Date)
SUBSCRIBED AND SWORN to before me this ____ day of _____________________, affiant personally exhibiting to
me his/her Community Tax Certificate No.____________ issued at __________ on ______________ and his/her Driver’s
License or Company ID with No. _______________ as competent evidence of identity.
Doc. No. ______
Page No. ______
Book No. ______ NOTARY PUBLIC
Series of _______
Application Requirements: (Except applications for PBB episodes)
1. Synopsis or Program Description.
2. Television Material for Review.
3. MTRCB Import Permit, as per Memorandum Circular No. 02-05, dated Feb. 14, 2005. (for imported materials only)
If the material for review has been previously approved for television exhibition, please attach photocopy of MTRCB Permit for
Television Exhibition. If application is for PBB episodes only, please attach photocopy of MTRCB Permit for Television
Exhibition of the program’s sample episode.
NOTE: After payment, please leave this application at Window 2 of the Registration Unit.