Name of Establishment *

Address *

Select Province/Office *

Select City/Town *

Tin Number *

Telephone Number *

Fax No.

Company Email

Name of Manager/Owner *

Nature of Business & Product Manufactured/Service rendered or Merchandise sold *

Number of Employees *

Union Information

Name of Labor Union, if any

Labor Union Address

BLR Registration No.

Technical Information

 Machinery, Equipment and Other Devices in Use (ex. circular saw, machine drill press, boiler, pressure vessel, internal combustion engine, engine diesel, gasoline, etc.)

 Materials Handling Equipment (ex. power trucks, hand trucks, conveyors, forklift, cranes, etc.)

 Chemical or Substances Used/Handled

Branch Unit

Name of Parent Establishment

Parent Establishment Address

Current Capitalization

Total Assets