GUIDELINES IN THE FILING OF APPLICATION FOR REGISTRATION UNDER BOOK 1 OF THE OMNIBUS INVESTMENTS CODE OF 1987

BOI FORM N-501 APPLICATION NO.: _________________

DATE ACCEPTED : _________________

REPUBLIC OF THE PHILIPPINES

BOARD OF INVESTMENTS

APPLICATION FOR REGISTRATION

(Hospital)

UNDER BOOK I OF THE OMNIBUS INVESTMENTS CODE OF 1987, AS AMENDED

(EXECUTIVE ORDER NO. 226)

I. PROPONENT

NAME OF ENTITY : ________________________________________________________________

NAME OF PROJECT : ________________________________________________________________

SEC/REGISTRATION NO./DATE : ______________________________________________________________

IPP CATEGORY : ____ Regular List ____ Mandatory List ____ Export Activities

LOCAL FOREIGN

OWNERSHIP RATIO : ___ % Filipino ___ % Foreign __________________

(Nationality)

II.CONTACT DETAILS

AUTHORIZED REPRESENTATIVE

TO BOI/POSITION : ________________________________________________________________

(attached Board Resolution Appointment)

EMAIL ADDRESS : ________________________________________________________________

LANDLINE/CELLPHONE NUMBER : __________________________ FAX NUMBER: ________________

OFFICE ADDRESS : ___________________________________________________________________________

PLANT/FARM/SITE ADDRESS : ________________________________________________________________

III. PROJECT PROFILE

PROJECT COST (Refer to Schedule 1):

PROJECT DESCRIPTION

TYPE OF PROJECT :

New: ______

Start of Commercial Operation: __________

Capacity: __________

Expansion: _________

% increase in capacity: __________

Modernization: _______

Existing: __________

STATUS:

_____________ Pioneer _____________ Non-Pioneer

CONTRIBUTION TO THE ECONOMY

Schedule 1: Project Cost (PhP)

Year 0Year 1Year 2Year 3Year 4Total

Land Cost

Cost of Licenses/ Permit from the Govt.

Site Construction Cost

Cost of Capital Equipment, Furniture and Fixtures

Hiring and Training Cost

Working Capital

TOTAL PROJECT COST

Schedule 2: Net Value Added [(Cost of Services- Cost of Purchases)/Cost of Services]Year

Particulars12345

Total Cost of Services* (PhP000)

Total Cost of Purchases**(PhP000)

Net value added

* Cost of Sales (plus Operating Expenses if Supplies and Utilities are part of opex)** Includes Food and Beverage, Supplies and Utilities costs.

Schedule 3: Job Generation

Number EmployedPre-OpYr1Yr2Yr3Yr4Yr5

Employees paid on monthly basis

Workers paid on a daily basis

Full-time workers paid by contractors

Others (Managers and Supervisors

TOTAL

Annual Payroll(PhP000)Pre-OpYr1Yr2Yr3Yr4Yr5

Employees paid on bi-monthly basis

Workers paid on a daily basis

Full-time workers paid by contractors

Others (Managers and Supervisors

TOTAL

Schedule 4: Timetable of the Project

ActivitySchedule (Month/Year)Related ExpensesCost

(PhP000)

Raw land CostLand Cost

Licenses/ Permit from the Govt.Pre-operating expenses

Site ConstructionCivil works

Acquisition and installation of equipment, furniture and fixturesCapital Equipment, Furniture and Fixture Cost

Hiring and training employeesTraining Cost

Start of Commercial OperationWorking Capital

Schedule 5: Project Financing (total should equal to project cost)Amount (PhP '000)%

Equity

Bank Loan

Others (specify)

Total100

Schedule 6: Status of Licensing, Permits, Consents

Licenses / Permits (indicate applicable only)NumberDate Issued

SEC Registration

License to Operate issued by DOH

Philhealth Accreditation

Others (specify)

Schedule 7: Current Stockholders Profile (as of filing date)

1.

2.

3

SCHEDULE 8: Projected Sales*

Year Service type Projected annual volume Annual Revenue Total Annual revenue (in Million Pesos)

1a.

b.

2a.

b.

3a.

b.

4a.

b.

5a.

b.

*Modify as appropriate

ATTACHMENTS:

A) Project Site- should be shown in Google Map (Satellite View). Sketches are not acceptable. (Also, indicate previously registered projects, if any).

B) Schematic Diagram showing Business Model of the Activity being registered (clearly indicate how the company will earn revenues and make a profit)

C) Other Sector-Specific requirements:

List of BOI-registered Projects DOT Endorsement (if applying under Tourism Act)

Copy of License to operate issued by DOH and Philhealth Accreditation (if applying under Hospital/Medical Services listing, as post-registration condition)

D) Projected Income Statement with ITH

OTHER DOCUMENTARY REQUIREMENTS

SEC Registration (for new applicant)/amendments, if any)

Latest Audited Financial Statements (for existing corporations)

Latest General Information Sheet (GIS) submitted to SEC

Board Resolution Authorizing Officer to represent the company (see format)

Publishers Affidavit of Publication of Notice

For projects applying as Expansion, last three years AFS and ITR.

SAMPLE FORMAT FOR SECRETARYS CERTIFICATE

SECRETARYS CERTIFICATE

I, (name of Corporate Secretary), of legal age, Filipino, being the duly elected and qualified Corporate Secretary of (name of applicant firm), a corporation duly organized and existing under the laws of the Philippines, with office address at (office address of applicant firm), 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 firm), (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 under the Omnibus Investments Code of 1987 (Executive Order No. 226) with the Board of Investments for its (proposed project activity) as (new)(expanding)(existing) (export) producer of ____________ under the 20___ Investment Priorities Plan.

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 _______

Projected Income Statement (with ITH)

In '000 PhP

YEAR 1YEAR 2YEAR 3YEAR 4YEAR 5

Total Sales/Revenue

Less: Sales Discounts

Net Sales/Revenue

Less: Cost of Goods Sold

Gross Profit on Sales/Revenue

Less: Operating Expense

Net Profit (Loss) from Operations

Add: Other Income, Net

Less: Interest Expense

Net Income Before Tax (NIBT)

Less: Corporate Income Tax (30% of NIBT)

Add: Income Tax Holiday (for Qualified Activities)

Net Income After Tax (NIAT)

(Name of Applicant Enterprise)

Projected Operating Expenses

In '000 PhP

YEAR 1YEAR 2YEAR 3YEAR 4YEAR 5

Selling Expenses:

Salaries and Wages

Fringe Benefits

Sales Commissions

Sales Tax

Advertising and Promotion

Delivery Expense

Representation and Entertainment

Normal Depreciation

Other Taxes and Licenses

Total Selling Expense

General and Administrative Expenses:

Salaries and Wages

Fringe Benefits

Normal Depreciation

Amortization of Pre-Operating Expense

Office Supplies

Other Taxes and Licenses

Communication, Light and Water

Transportation and Travel

Total General and Administrative Expense

Total Operating Expenses

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