RA9290 Application form – Enterprise

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Form R. A. 9290-1 (For Footwear, Leather Goods & Tannery Enterprise)Application No.

APPLICATION FOR ACCREDITATION

Under Footwear, Leather Goods and Tannery Industries Development Act (R.A. 9290)

(Please check or fill up blank spaces)FOOTWEAR, LEATHERGOODS, TANNERY ENTERPRISE CATEGORY

New / : / ______/ __ / Micro jewelry enterprise / (<P1,500,000)*
Renewal / : / ______/ __ / Small scale jewelry enterprise / (P1.5M-15M)*
Accreditation valid until / : / ______/ __ / Medium scale jewelry enterprise / (P15M-100M)*
__ / Large scale jewelry enterprise / (>P100M)*
  1. BASIC INFORMATION

Name of Firm:
Office Address:
Factory/Plant Address:
Tel. No. / Fax No.
Contact Person / Position:
Year Established
DTI/SEC/CDA Reg. No.: / Date:
BIR Reg. No. / Date:
BOC Customs Intelligence and Investigation Service (CIIS) Reg. No.: / Date:
Legal Personality:
____Single Proprietorship ____Partnership ___Corporation ___Others (Cooperative, etc.)

Principal Officers:

President:
Vice President:
Treasurer:
Secretary:

Equity Profile:

Name / Nationality / Capitalization (Php)
  1. PROJECT COST AND SOURCES OF FINANCING (To be filled up by New Applicant)

Project Cost (Php)
Building / ______
Machinery and Equipment / ______
Installation and other Cost / ______
Financial Charges / ______
Working Capital / ______
Others (Please Specify) / ______
Total Project Cost / ______
Sources of Financing / Amount (Php)
Equity:
Local / ______
Foreign / ______
Loans / ______
Others / ______
Other Financing / ______

*Assets including loan but excluding land

  1. LABOR GENERATION

Labor / No. of Employment
Direct
Indirect
Administrative
  1. REGISTRATION UNDER OTHER LAWS (BOI, PEZA, EDA, etc.)

Law: / ______/ Law: / ______
Registration No.: / ______/ Registration No.: / ______
Date Registered: / ______/ Date Registered: / ______
  1. ACTIVITIES IN THE MANUFACTURE OF FOOTWEAR/LEATHER GOODS/TANNERY INDUSTRY UNDER R.A. 9290

Activity:
Annual Capacity:
Manufacturing Process:
  1. SALES PERFORMANCE FOR THE PAST THREE (3) YEARS (To be filled up by Existing Footwear, Leather Goods and Tannery Enterprises)

Year / Domestic / Export / Total
Quantity / Value (Php) / Quantity / Peso Equivalent (Php) / Quantity / Value (Php)
  1. ARE THERE ACTIVITIES OTHER THAN FOOTWEAR, LEATHER GOODS AND TANNERY MANUFACTURING?

No ______

Yes ______If Yes, please indicate below

Activity / Ave. Annual Sales (Php)

I hereby certify that the above information are true and correct and that relevant documents shall be made available to verify the same, if necessary.

______

Signature over printed name

______

Position

Subscribed and sworn to before me this ______day of ______, 20______with the affiant exhibiting to me his/her Residence Certificate No. ______dated ______, issued at ______.

NOTARY PUBLIC

Doc No.

Page No.

Book No.

Series of

ANNUAL BUSINESS PLAN

______to ______

Month Year Month Year

  1. RAW MATERIALS, SUPPLIES AND EQUIPMENT PROPOSED FOR ACQUISITION

RAW MATERIALS / SUPPLIES
Description / Quantity / Amount
LOCAL / Php
Subtotal / Php
IMPORTED / US$
Subtotal / US$
MACHINERY, EQUIPMENT, TOOLS, AND SPARE PARTS
Description / Quantity / Amount
LOCAL / Php
Subtotal / Php
IMPORTED / US$
Subtotal / US$
TOTAL LOCAL / Php
TOTAL IMPORTED / US$
PORT/S OF ENTRY:

(Please attach additional sheet, if necessary)

  1. PROJECTED PRODUCTION AND SALES

Activity / Quantity / Value
A. Total Production
In house / Php
Subcontracted / Php
B. Domestic Sales / Php
C. Export Sales / US$
D. Countries of Destination:

Submitted by:

______Signature over printed name

______Position