City Municipality of Santa Rosa

Application Form for Business Permit

Tax Year

ANNEX 1(PAGE1 OF 2)

1. Provide accurate information and print legibly to avoid delays Incomplte applications form will be returned to the applicant.

2. Ensure that all documents attached to this form (if any) are complete and properly filled out.

1. Basic Information

New Applicant

Renewal

Mode of Payment

Anually

Semi-Anually

Quarterly

Please select Mode of Payment.

Date of Application

DTI/SEC/CDA Registration NO.:

TIN no.: Invalid or incomplete TIN format. Please enter 12 digits in the format 000-000-000-000.

Type of Business:

Single

Partnership

Corporation

Cooperative

Please select Type of Business.

Ammendment: From

Single

Partnership

Corporation

Please select Amendment From

     Ammendment: To

Single

Partnership

Corporation

Please select Amendment To.

Are you enjoying tax incentive from any Government Entity?

Yes

No

Others, specify:

Fields Required

Name of Taxpayer/Registrant

Last Name

First Name

Middle Name

Suffix

Business Name:

Trade Name/Francise:

OTHER INFORMATION

Note: For renewal applications, do not fill up this section unless certain information have changed.

Business Address

Postal Code:

Email Address:

Please use a valid Email.

Telephone No.:

Mobile No.:

+63

Please enter a valid contact number (must start with 9 and have 10 digits).

Owner's Address

Postal Code:

Email Address:

Please use a valid Email.

Telephone No.:

Mobile No.:

+63

Please enter a valid contact number (must start with 9 and have 10 digits).

In case of emergency, provide name of contact person:

Telephone/Mobile No:Contact Person

+63

Please enter a valid contact number (must start with 9 and have 10 digits).

Email Address:Contact Person

Please use a valid Email.

Business Area (in sq.m):

Total No of Employees in Establishment:

No. of Employees Residing within LGU:

Note: Fill Up Only if Business Place is Rented:

Lessor's Fullname

Lessor's Address

Lessor's Telphone/Number No.:

+63

Please enter a valid contact number (must start with 9 and have 10 digits).

Lessor's Email Address:

Please use a valid Email.

Monthly Rental:

3. BUSINESS ACTIVITY

Line of Business	No. of Units	Capitalization For New Business	Essential	Non-Essential

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This form, provided by the Local Government Unit of Santa Rosa, supports individuals applying for PWD registration. Data Privacy Notice Your information is protected under the Philippine Data Privacy Act (RA 10173) and will only be used to process your application and assess benefits eligibility. We ensure your data is secure, confidential, and handled exclusively by authorized personnel within Santa Rosa LGU. Thank you for trusting us to keep your information safe.