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FSED 002 - Application Form FSIC

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BUREAU OF FIRE PROTECTION

AUTOMATED CLEARANCE SYSTEM


Service Made FAST- EASY - RELIABLE (02) 426 0219 / 426 0246
www.bfp.gov.ph
FSI
APPLICATION FORM
CHECK BOX OF CLEARANCE APPLIED FOR
FIRE SAFETY INSPECTION CERTIFICATE

FIRE SAFETY INSPECTION


FIRE SAFETY INSPECTION CERTIFICATE For Issuance of Business Permit/ Certificate of
For Issuance of Occupancy Permit Annual Inspection for PEZA
NEW BUSINESS RENEWAL

Business Identification Number (BIN) Tax Identification Number (TIN)

NAME OF
OWNER
ESTABLISHME
NT NAME
TRADE BUSINESS
NAME NATURE
EXACT BUSINESS
ADDRESS
LANDLINE/FAX CELLPHONE NUMBER EMAIL ADDRESS

AUTHORIZED REPRESENTATIVE
(If Applicant is not the Owner)

ATTACHED DOCUMENTARY REQUIREMENTS


FSIC FOR OCCUPANCY PERMIT FSIC FOR BUSINESS PERMIT
[ ] COPY OF APPLICATION FORM FOR CERTIFICATE OF [ ] BUSINESS PERMIT APPLICATION FORM OR TAX
OCCUPANCY FROM OFFICE OF THE BUILDING OFFICIAL ASSESSMENT BILL FROM THE BUSINESS PERMIT AND
OR ASSESSMENT OF FEES FROM OBO LICENSING OFFICE
[ ] PHOTOCOPY OF CERTIFICATE OF COMPLETION [ ] COPY OF FIRE INSURANCE (IF ANY)
[ ] AS-BUILT PLAN (If Necessary) [ ] AFFIDAVIT OF UNDERTAKING OF NO
ALTERATION TO BUILDING (For NEW Business
NOTE: Incomplete documentary requirements will be with Valid FSIC Issued for Occupancy)
returned to the applicant.
I hereby certify the correctness of the information provided above and the completeness of the
attached documents.

________________________________ _____________________
SIGNATURE OVER PRINTED NAME DATE

VERIFIED BY: DATE


RECEIVED
TIME
RECEIVED
BFP-QSF-FSED-002 REV.00 (06.01.18)

CLAIM STUB

CERTIFIED BY:
_________________________ ______________________
C CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
APPLICATION
FSI
CONTACT INFORMATION: ____________________________________ email:
__________________________________

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