PhilExport 4C Cavite Chapter Form

I. Company Profile

Registered Name *

Trade Name *

Company TIN *

Business Address

City *

Province / Zip Code *

Region *

Telephone No. *

Include area code*

Fax No. *

Mobile No. *

Alternate Mobile No. *

Email Address 1 *

Email Address 2 *

Website

FB/Messenger

Factory (If different from Office)

Check if Yes

Representative Information

Salutation *

Official Representative *

This is the name you would like to be called. (e.g. Juan Dela Cruz)

Designation *

Salutation

Alternate Representative *

Official Representative Name

Designation *

Organization Information

Name of Organization/Association *

(indicate complete name)

Form of Organization *

Corporation

Single Proprietorship

Partnership

Cooperative

Registration Number *

SEC/DTI/CDA No

Date of Registration *

Size of Company by Assets Total Assets (excluding land) OR tick off on opposite row *

Micro (Php 3,000,000 and below)

Small (Php 3,000,001–Php 15M)

Medium (Php 15,000,001–Php 100M)

Large (Php 100,000,001 & above)

No. of Regular Office Employees *

No. of Contractual Office Employees *

No. of Regular Factory Employees *

No. of Contractual Factory Employees *

Year Established *

II. Additional Information

Owner Name *

Position *

Birthday *

Gender *

Sector (Products) *

Sector (Services)

Please list detailed product line for buyer-seller matching.

Product/Services *

Specific Country-Markets *

Specific Country-Markets 2

Specific Country-Markets 3

Specific Country-Markets 4

Approximate Previous Year Export Sales *

Do you do Online Marketing? *

Instagram

E-Marketplace (Alibaba, Lazada, Shopee, etc.)

Others

Imported Raw Materials 1 *

Country Source *

Imported Raw Materials 2

Imported Raw Materials 2 *

% Value added to Export Production & Cost

Value Added *

Labor *

% to Export Production & Cost *

Raw materials. Please specify:

Local 1 *

Imported 1 *

Local 2

Imported 2

Local 3

Imported 3

Local 4

Imported 4

Local 5

Imported 5

Power/Energy *

Transport/Logistics *

Please indicate any Quality/Standards Certification (e.g. ISO, HACCP, Organic, etc.) if any

Certification 1 *

(e.g. ISO, HACCP, Organic, etc.)

Inclusive Dates 1 *

(from – to) (mm/dd/yyyy)

Certification 2

(e.g. ISO, HACCP, Organic, etc.)

Inclusive Dates 2

(from – to) (mm/dd/yyyy)

Certification 3

(e.g. ISO, HACCP, Organic, etc.)

Inclusive Dates 3

(from – to) (mm/dd/yyyy)

The undersigned hereby certifies that the information contained herein are true to the best of my knowledge. *

Chairman

CEO

President

Official Representative

Date *

Application Requirements

1. Accomplished Application Form

2. Photocopy of:

For Corporation – SEC Registration and Articles of Incorporation, By-Laws and General Information Sheet

For Partnership – SEC Registration and Articles of Partnership

For Single Proprietorship – DTI Registration

For Cooperative – CDA Registration

For Barangay Micro Business Enterprise (BMBE) – BMBE Certification

3. Updated BIR Certificate of Registration (Form No. 2303)
4. Mayor’s Permit
5. Latest Financial Statement
6. Photos of Products or Brochure of Services
7. One (1) 2”X2” colored picture of Authorized Representative /Owner
8. Not included in the DTI Watchlist

SCHEDULE OF MEMBERSHIP FEES

1. PHILEXPORT PE4C Cavite Chapter Annual Membership Fee One-time Entrance Fee. [₱ 3,000.00]
2. Regions and Sectoral Business Support Organizations (BSOs) have varying fees approved by their respective Boards. [₱ 700.00]

Please make your check payable to Philippine Exporters Confederation, Inc. *

NOTE:

In lieu of physical plant inspection, pictures of plant/office/products using “GPS Camera” or “GPS Map Camera” applications should be submitted as follows:

a. Facade and interior photos of the company’s office and warehouse with the company’s signage.
b. Pictures of company’s products. c. Wall-posted Government permits. (eg. Mayor’s Permit, BIR 2303, SEC Registration, DTI Registration, etc.)

SIGNATURE CARD

Upload your picture here *

Upload your documentary requirements here *

Name *

Trade Name *

Address *

City *

Province/Region *

Zip/Postal Code *

Country *

Personal TIN No. *

Telephone No. *

Mobile No. *

Official Representative *

Alternate Representative *

THIS IS CERTIFY THAT THE ABOVE-MENTIONED PERSONS ARE THE OFFICIAL REGISTERED REPRESENTATIVES OF OUR COMPANY TO PHILEXPORT

Certified By *

Date *

(PLEASE NOTIFY PHILEXPORT PROMPTLY OF ANY CHANGE IN THE ABOVE INFORMATION)

DATA PRIVACY DISCLAIMER

Data Privacy Statement and Consent Form as PHILEXPORT member

Accept *

I understand and agree that by my voluntary engagement of the services of PHILEXPORT, and byproviding my personal information, I am giving consent to PHILEXPORT to collect, store, access, shareand process my personal data, whether manually or electronically, which will be used for the purposesof membership with PHILEXPORT, including use of the Common Bonded Warehouse.

I am aware of and understand my rights under the Data Privacy Act of 2012 and that while I have the right to object, it is still necessary for PHILEXPORT to collect, store, access, share and process my personal data to inform me of developments and programs, invitations for seminars, workshops and other activities; and enable PHILEXPORT to implement other legitimate services such as advocacy, advisory and facilitation, import & export accreditation & documentation, business matching, project development & management and information collection & dissemination.

I am aware that no person other than the relevant PHILEXPORT employees, are authorized to access my personal data held in the database, and that all persons who need to access and process my information are required to maintain its confidentiality and compliance with privacy laws.

I also acknowledge and warrant that this waiver frees PHILEXPORT, its officers and employees from any complain, law suit, or damages in relation to this process.

I confirm that the contents of this consent form have been explained to me in terms that I understand and that I agree to the provisions stated above. My signature below signifies my voluntary consent to the above.

Submit