8/13/2019 PRPA Form

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Republic of the PhilippinesDepartment of Labor and Employment

Regional Office No. _____

APPLICATION FOR LICENSE TO OPERATE APRIVATE RECRUITMENT AND PLACEMENT AGENC

NAME OF AGENCY: ___________________________________________________________________ADDRE OF AGENCY: ________________________________________________________________

!"N No. ____________________ !E#$FA% Nos. ______________________________________________

T PE OF !USINESS ORGANI"ATION : & Please check '

( ) ole P*op*ieto*ship ( ) Pa*tne*ship ( ) Co*po*ation

Date of Regist*ation: _____________________ Reg. No. ______________________________

COMPRE#ENSIVE DESCRIPTION OF OPERATION$ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ FINANCE$

!otal Assets: _________________________________ +an, tate-ent _____________________________

!otal #iabilities: ______________________________ Date of tate-ent ___________________________

Net o*th: ______________________________________________________________________________

Pai/0in0Capital: _________________________________________________________________________

Date of tate-ent: _______________________________________________________________________

MANAGEMENT AND STAFF$ NAME DE "GNA!"ON ADDRE

"n itness he*eof1 " ha2e he*eunto affi3e/ -4 signatu*e this __________ /a4 of __________________1 56___ in ___________________.

_______________________________________ &Applicant7s Na-e an/ ignatu*e'

8+ CR"+ED AND 9ORN to befo*e -e this ______ /a4 of ______________1 56____ in _________________1

Applicant e3hibiting to -e his$he* Resi/ence Ce*tificate No. _________ issue/ at _______________________ on

_______________________.

NO!ARY P8+#"CDoc. No. __________ Page No. __________ +oo, No. __________

e*ies of __________

8/13/2019 PRPA Form

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List of Requirements for PRPA License

1. Accomplished Application Form,

a. A filing fee of One Thousand Pesos (P1000.00); if single proprietor; and P3,000 ifcorporation or partnership;

. !ertified cop" of the !ertificate of #egistration of firm or usiness name fromthe $epartment of Trade and %ndustr" ($T%), in the case of single proprietorship;or a certified cop" of the Articles of Partnership or %ncorporation dul" registered&ith the 'ecurities and change !ommission (' !), in the case of apartnership or a corporation;

c. A s&orn statement of assets and lia ilities and*or a dul" audited financialstatement, as the case ma" e;

d. O&ner+s certificate*title of office location or contract of lease of office space for

at least t&o ( ) "ears;

e. - % clearance of the applicant, or the partners in the case of a partnership or allthe officers and mem ers of the oard of $irectors, in the case of a corporation;

f. %ncome Ta #eturns for the last t&o ( ) "ears;

g. A /erified underta ing that the applicant shall

(1)not engage in the recruitment of children elo& 12 "ears of age or placechildren elo& 1 "ears old in ha4ardous occupation in accordance &ith#epu lic Act -o. 5610 as amended " #epu lic Act -o. 562 and otherrelated la&s; and

( )assume full responsi ilit" for all claims and lia ilities &hich ma" arise inconnection &ith the use of the license;

h. Organi4ational structure and list of all officers and personnel &ith theirrespecti/e io7data, t&o ( ) passport7si4e %$ pictures and a detailed descriptionof their duties and responsi ilities;

i. 'pecific address and location map of the Office*proposed Office; and 8. 9ist of all authori4ed representati/es, if an", &ho must e at least high school

graduate, &ith their corresponding io7data, t&o ( ) passport7si4e %$ pictures,high school diploma or other proof of educational attainment dul"authenticated, - % clearance and 'pecial Po&er of Attorne" ('PA).

Note No application shall be accepted, unless all the requirements have been compliedwith.