BOI FORM 501 APPLICATION NO. :Agri, Fishery & Other Resource-based Projects DATE ACCEPTED :(Revised as of 01 December 2014)

REPUBLIC OF THE PHILIPPINESBOARD OF INVESTMENTS

APPLICATION FOR REGISTRATIONUNDER BOOK I OF THE OMNIBUS INVESTMENTS CODE OF 1987 AS AMENDED

(EXECUTIVE ORDER NO. 226)A. APPLICANTNAME OF ENTITY :OWNERSHIP : % Filipino % Foreign (Nationality)TAX ACCOUNT NO. :SEC REGISTRATION : No. : Date :OFFICE ADDRESS :

ZIP CODE :TELEPHONE NO. : FAX NO. :

AUTHORIZED OFFICER:NAME :DESIGNATION :LANDLINE NO. : FAX NO. :MOBILE NO. : E-MAIL ADDRESS :

AUTHORIZED REPRESENTATIVE TO BOI:NAME :ADDRESS :

LANDLINE NO. : FAX NO. :MOBILE NO. : E-MAIL ADDRESS :

B. ACTIVITY/ AREA OF INVESTMENT APPLIED FORIPP Category : Regular List Mandatory List Export Activity as listed in the IPP :Type of Project: New Expansion Existing Modernization

% Increase in Capacity

Status: Non-Pioneer Pioneer Basis for Pioneer Status:

Name of Project :Specific Products/Services :Production Capacity/Year :Project Location :Start of Commercial Operation :

BOI Form No. 501, Page 2 of 6

PROJECT REPORT 1) PROJECT DESCRIPTION

Attachment: Business Model of the activity being registered (clearly indicating amongBusiness Model of the activity being registered (clearly indicating among others, all revenue-generating activities of the enterprise, including the activitiesothers, all revenue-generating activities of the enterprise, including the activities proposed for BOI registration)proposed for BOI registration)

2) PROJECT LOCATION - Provide description and Google map of the project site

3) PROPOSED MARKET/CLIENTS(Add rows, if necessary)Name of Buyers/Clients Market/Country

Attachment: Proof of Assured Market: Copy of Power Supply Agreement, Purchase Orders or Letters of Intent, etc.

4) PRODUCTION AND TECHNOLOGY: a. Raw Materials (Add rows, if necessary)

Description Cost per Unit of Raw Material

Raw Material Usage Rate per Unit of Finished

ProductSupplier Country

Source

Indicate applicable units of measure, e.g., metric tons, liters, etc.Net Value Added:

Y1 Y2 Y3 Y4 Y5Costs in (PhP):

Total Production Imported Raw Material Local Raw Material

Net Value Added (NVA) -% NVA -to be computed by BOI Y1 is the first year (12-month period) of commercial operations

b. Machinery and Equipment (Add rows, if necessary)Equipment Country Source End-use Qty (No. of units) Unit Cost (PhP) Total Cost (PhP)

Total: (A)End Use is the application or processing step where the equipment will be used

Breakdown of Machinery & Equipment Costs, as to source and status of acquisition Status of

AcquisitionCost of Locally Sourced (PhP)

Cost of Imported (PhP) Total Cost (PhP)

Already acquiredFor acquisition

Total: (A)c. Process: Provide Process Flow Chart, with Description of Each Process

5) PROJECT TIMETABLE/COST:Activity Schedule

(Month/Year) Related Expenses Cost (in PhP)

Obtaining licenses, permits, registration

Pre-operating expense

Project Site preparation & Land

BOI Form No. 501, Page 3 of 6

development Hiring of Contractors Civil works

Land improvementsBuildingLeasehold Improvements Other expenses

Acquisition and installation of machinery & equipment

Machinery & equipment: (A)

Start of commercial operation Working capital (__ months)

Total Project Cost (B)Working capital normally covers the first three to four months of commercial operationsYearly Investment Requirement (For projects with a gestation period of more than one year)Add columns, if necessary

Pre-Operating Period TotalYearInvestment Requirement (PhP) (B)Total Investment Requirement should tally with the Total Project Cost

6) PROJECT FINANCING Sources of Funds Amount in PhP % to Total

Equity Loan

Total Financing (B)Total Financing should tally with the Total Project Cost

Provide also information on:a. Name of Bank from which the loan will be secured; and,b. Collateral for the loan; and,

7) PROJECTED PRODUCTION & SALES SCHEDULE:

YearProduction Volume

Sales Volume (No. of units)

Average Selling Price per Unit Total Sales Value

Domestic Export Domesti

c (PhP)Export (PhP)

Domestic (PhP)

Export (PhP)

Total(PhP)

12345

Indicate unit of measure (e.g., metric tons, liters, etc.) Projected annual production volume should not exceed the production capacity per year being applied for BOI

registrationAssumptions Used in the Projections:o Y1 is the first year (12-month period) of commercial operationso Foreign Exchange Rate Used (in PhP per

USD)o No. of shifts per dayo No. of Operating days per yearo Basis for the selling price(s)o Others

8) JOB GENERATION Employee Type No. of employees Annual Payroll (PhP’000)

Y1 Y2 Y3 Y4 Y5 Y1 Y2 Y3 Y4 Y5Direct LaborIndirect LaborAdministrative/Sales

Total:Y1 is the first year (12-month period) of commercial operations

BOI Form No. 501, Page 4 of 6

9) FINANCIAL PROJECTIONS (preferably in Excel format):Provide 2 sets of Projected Income Statements for 10 years*, with itemized Cost of Sales, Manufacturing Overhead and Operating Expenses including breakdown on real property taxes, licensing and business permits, etc. 1 Set WITH Income Tax Holiday (ITH)* , 1 Set WITHOUT ITH , i.e., with corporate tax rate of 30% from Year 1 (Year 1 is the first 12-months of

commercial operations)Note: ITH period depends on the type and status of registration; with corporate tax rate of 30% after the ITH period.

10) JUSTIFICATION FOR PIONEER STATUS (IF APPLICABLE)

BOI Form No. 501, Page 5 of 6

11) FOR MODERNIZATION PROJECTS Compliance to 25% Substantial Reduction of Total Production Cost

Production Cost Before

Modernization

Production Cost After

Modernization

Substantial Reduction Cost on Production cost

   Amount

Difference Percentage

(A) (B) A-B = (C) C / TCGSTotal Raw Materials        

 Local         Imported        

Direct Labor        Manufacturing Overhead:         

Utilities:         Electricity

Water Communication Total Utilities

Other Manufacturing Overhead: Indirect Labor         Factory Supplies         Insurance Expenses         Depreciation & Amortization         Repairs & Maintenance         Others

Total Other Manufacturing OverheadTotal Cost of Goods Sold (TCGS)      

(25% minimum)

Matrix of Machines and Equipment (Existing & Replacement) (Add rows, if necessary)

Process Flow/

Section

Existing Machines & EquipmentReplacement Machines &

Equipment under Modernization Program

Machine Type/Mode

l

Age/ Year

Acquired

Quantity

ActualProductio

n Capacity

End-Use

Quantity

Production

Capacity

Expected Efficiency

\12) IF THE APPLICATION FOR REGISTRATION COVERS EXPANSION or

MODERNIZATION/UPGARDING OF AN EXISTING PROJECT: Actual Production & Sales (Volume & Value) for the past three (3) years

Year

Installed

Capacity

Production

Volume

Sales Volume (No. of units)

Average Selling Price per Unit Total Sales Value

Domestic

Export

Domestic (PhP)

Export (PhP)

Domestic

(PhP)

Export

(PhP)

Total(PhP)

BOI Form No. 501, Page 6 of 6

Indicate unit of measure (e.g., metric tons, liters, etc.)YEARo Foreign Exchange Rate

Used (in PhP per USD)o No. of shifts per dayo No. of Operating days per

yearo OthersAttachment: Plant and machinery Lay-out providing distinction as to the existing/currently installed facilities vis-a-vis proposed facilities covered by the application for BOI registration

13) PROJECT PROPONENTSFOR SOLE PROPRIETORSHIP

Name Nationality Country of Residence Capital (In Pesos)

FOR CORPORATION/PARTNERSHIPSAuthorized Capital

PhP

Stockholders (Add rows, if necessary)

NameNationality

(indicate with * if naturalized Filipino)

Country of

Residence

Subscribed Capital Paid-Up Capital

% Ownershi

pNo. of Shares

Value

No. of Shares

Value

Total:Directors (Add rows, if necessary)

Name Nationality Country of Residence

Principal Officers) (Add rows, if necessary)Name Nationality Designation

Attachment for enterprises which are not newly-incorporatedfor enterprises which are not newly-incorporated: : Copy of Latest General Information Sheet (GIS) Copy of Latest General Information Sheet (GIS) Copy of Audited Financial Statements (past 3 Years)

a. BACKGROUND ON THE APPLICANT ENTERPRISEIncluding but not limited to applicant enterprise’s and its stockholders’ previous and current businesses other than the proposed project being applied for BOI registration.

b. AFFILIATES OF THE APPLICANT ENTERPRISE(if applicable)(Add columns/rows, if necessary)Applicant Enterprise

Parent Company

Affiliate 1 Affiliate 2

Business ActivitiesLocation of ProjectsBOI Reg’n No./ DateStart of Commercial Operations

Name of Stockholders Nationality % Ownership % Ownership % Ownership % Ownership

BOI Form No. 501, Page 7 of 6

c. EXISTING PROJECTS OF THE APPLICANT ENTERPRISE(Add columns, if necessary)

Project 1 Project 2 Project 3 Project 4Business ActivitiesLocation of ProjectsCapacity of ProjectsStart of Commercial OperationsBOI Reg’n No./ Date (if applicable)

OTHER ATTACHMENTS:a. Copy of SEC Certificate of Registration, Articles of Incorporation/Partnership and By-Laws, Copy of SEC Certificate of Registration, Articles of Incorporation/Partnership and By-Laws, (the primary/secondary

purpose should cover the activity being registered with the BOI); or Copy of DTI Certificate of Registration (for sole proprietor)

b. Secretary’s Certificate re: applicant enterprise’s Board Resolution authorizing its officer/ official representative to transact with BOI, execute and sign all documents in behalf of the applicant enterprise pertaining to the application for BOI registration. (Use BOI format)

c. Copy of Environmental Compliance Certificate/ Certificate of Non-Coverage (ECC)/CNC), whichever is applicable for the project; or information on the status of application for ECC/CNC

d. Endorsement of the Department of Agriculture – in the case of Agri-Fishery projects, commercial production.e. Other documents that may be required by the Board during the course of the evaluation of the project:

Note: Provide also electronic copy of the Application Form, Project Report including Financial Projections in preferably in word 2003 or Excel 2003 format

The applicant has read the Omnibus Investment Code of 1987 and the Rules and Regulations adopted by the BOI and commits itself to abide by the provisions thereof.

DONE IN THE CITY/PROVINCE OF

THIS

DAY OF

20

.

Applicant/Authorized OfficerREPUBLIC OF THE PHILIPPINESCITY/PROVINCE OF

) S.S.

MUNICIPALITY OF

)

SUBSCRIBED AND SWORN to before me this

day of 20

in

the City/Province of affiant exhibited to me his Residence

Certificate No. issued at on

20

.

NOTARY PUBLIC

Until Dec. 31,

BOI Form No. 501, Page 8 of 6

Doc. No. :Page No. :Book No. :Series of :

SAMPLE FORMAT (Use separate sheet) SECRETARY’S CERTIFICATE

I, (name of Corporate Secretary), of legal age, Filipino, being the duly elected and qualified Corporate Secretary of (name of applicant enterprise), a corporation duly organized and existing under the laws of the Philippines, with office address at (office address of applicant enterprise), under oath, do hereby certify that at the special meeting of the Board of Directors of the Corporation held on (date of special meeting), the following resolution was unanimously adopted:

RESOLVED, that (name of officer of enterprise), (position of officer) be as it hereby, authorized to transact, execute and sign all documents in behalf of the Corporation pertaining to its application for registration with the Board of Investments (BOI) under the Omnibus Investments Code of 1987 (Executive Order No. 226) for the (proposed project/ activity) as (New)(Expanding)(Existing) (Export) Producer, of ____________________________________ under the 20___ Investment Priorities Plan (IPP) of the BOI.

IN WITNESS WHEREOF, I have hereunto affixed my signature this __________ day of _____________, 20___ at __________________________.

Corporate Secretary

Subscribed and Sworn to before me this __________________ at _______________, affiant exhibited to me his CTC No. ____________________ issued on ___________________ at ___________________.

Notary Public Doc. No. _______Page No. _______Book No. _______Series of _______

BOI Form No. 501, Page 9 of 6