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    Doe Application For Registration (Annex4)

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    msigravity

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    Doe Application For Registration (Annex4)

    Uploaded by

    msigravity
    7 views2 pages

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    doe_application_for_registration(annex4)

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    7 views2 pages

    Doe Application For Registration (Annex4)

    Uploaded by

    msigravity

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines

    DEPARTMENT OF ENERGY
    Annex 4
    September 2022

    Application for Registration by a Dealer or Retailer – Authority to Sell a Trademark or tradename


    (via LPG-filled pressure vessel)

    Date: April 25, 2024 .

    Department of Energy- Visayas Field Office


    Energy Industry Management Division
    3rd Floor, Escario Building, Escario Street
    Cebu City

    Dear Sir/Madam:

    In compliance with the Department Circular No. 2022-11-0037, we wish to inform you of this application
    with the following details below:

    A. Company Details

    1. Company Name:
    2. Business Address:
    3. GPS Coordinates (longitude & latitude):
    4. Telephone Number:
    5. Email Address:

    B. Establishment Details

    1. Establishment Business Name:


    2. Business Address:
    3. GPS Coordinates (longitude & latitude):
    4. Telephone Number:
    5. Email Address:

    C. Application Details

    1. Type of Application : ( ) First ( ) Additional

    D. Supporting Documentary Requirements.

    Certified true copy of the following:

    1. Notarized certificate of the existence of a contract to sell duly signed by both the Dealer or
    Retailer and the Trademark owner or Marketer;
    2. LTO of Dealer or Retailer;
    3. LTO of Trademark owner or Marketer;
    4. DOE registration certificate - Trademark or tradename;
    5. DOE registration certificate – LPG Seal; and
    6. Notarized company secretary’s certificate of the authorized representative of the applicant.

    3rd Floor, Escario Building, 731 Escario Street, 6000, Cebu City, Philippines
    Tel. No. (Trunkline) (032) 253-2150, 253-3459, 253-7222
    Website:http://www.doe.gov.ph; E-mail: [email protected]
    Very truly yours,

    ___________________________________
    Name, designation & signature of applicant
    or authorized representative
    Reminder/ Instructions:

    1. Submit this application form with complete documentary attachments to DOE-VFO for the issuance of registration before the
    start of sale of an LPG-filled pressure vessel with a Trademark or tradename;
    2. Pay the application fee based on the DOE-VFO order of payment via cash, postal money order/manager's check or cashier’s
    check payable to the Bureau of the Treasury;
    3. Issuance of registration shall not be later than twenty (20) working days from the official receipt of the complete application; and
    4. Refer to Sections 21 and 31 of this Department Circular on the DOE handling office of this application.

    ACKNOWLEDGMENT

    REPUBLIC OF THE PHILIPPINES )


    CITY/MUNICIPALITY OF _____________ ) S.S

    BEFORE ME, a Notary Public for and in the City/Municipality of ____________________, this ___
    day of __________ 20__, personally appeared presenting his/her identification, to wit:

    Competent Evidence of
    Name Date & Place of Issue
    Identity

    known to me and to me known to be the same person who executed and voluntarily signed the foregoing
    application, which he/she acknowledged before me as his/her own free and voluntary act and deed, and
    with full authority to sign in that capacity.

    This application consisting of _______ (__) original copy/ies submitted to DOE-VFO with complete
    attachment, duly signed by the applicant.

    IN WITNESS WHEREOF, I have hereto set my hand on the day, year and place above the written.

    NOTARY PUBLIC

    Doc No. ______


    Page No. ______
    Book No. ______
    Series of 20______

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