Form SRA-03A
Revised, 2016
APPLICATION FOR LICENSE TO OPERATE AS TRADER
SUGAR REGULATORY ADMINISTRATION
North Avenue, Diliman, Quezon City
P.O. Box 90 U.P. Diliman
Quezon City 1101
Attention:
Gentlemen:
Passport size
picture 50 mm
wide X 70 mm
high (2 inches
wide X 2-3/4
inches long)
REGULATION DEPARTMENT
I HEREBY APPLY for license/s for Crop Year ________ - _________ , to operate as (Please see
asterisk) and engage in Sugar/Molasses/Muscovado trading in accordance with existing laws, decrees and
implementing rules and regulations promulgated by the Sugar Regulatory Administration (SRA). For this
purpose, I HEREBY SET FORTH the following information:
(* Mark appropriate box with an X)
DOMESTIC SUGAR TRADER
INTERNATIONAL SUGAR TRADER
(EXPORTER/IMPORTER)
INTERNATIONAL MOLASSES TRADER
(EXPORTER/IMPORTER)
MUSCOVADO TRADER/NON-PRODUCER
MOLASSES TRADER
MUSCOVADO TRADER
MUSCOVADO TRADER/PRODUCER
1. Firm/Business name:
_________________________________________________________________________
a) Type of Application
New
Renewal
2. Business Address: _________________________________________________________
Contact No/s. : ________________________________ Fax No. ___________________
E-mail Address : __________________________________________________________
3.
Business Information:
(a) Type of Organization:
______________________________________________________________________
(Single Proprietorship, Partnership, Corporation, Cooperative)
(b) Proprietor / Managing Partner / President:
______________________________
(Name and Position)
__________________________
(Nationality)
(c) Official/Authorized Representative to sign reports and other pertinent documents:
Name and Position
1. ____________________________
2. ____________________________
3. ____________________________
Specimen Signature
_______________________
_______________________
_______________________
(d) Number of years in sugar / molasses / muscovado trading: ___________
(e) Area of operation/distribution outlets (specify name of province, city or municipality covered):
_____________________________________________________________
(f) Warehouse (For Sugar and Muscovado)
Number of warehouse/s: ________________________________________________
Location : ____________________________________________________________
Dimension (Per Meter- Length x Width x Height) : ____________________________
Made of (materials): ____________________________________________________
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Capacity : _____________________________________________________________
Please attached separate sheet for more than one (1) warehouse
Storage/Container (For Molasses)
Number of warehouse/tanks: _____________________________________________
Location: ______________________________________________________________
Dimension (Per Meter- Length x Width x Height) : _____________________________
Made of (materials): ____________________________________________________
Capacity: _____________________________________________________________
4. Supporting documents for three (3) sets of application Submit one (1) copy of each document per
application.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
City/Municipality Business Permit
Mayor’s Permit
Certificate of Registration of firm/business issued by Department of Trade & Industry (DTI)
Securities and Exchange Commission (SEC) registration
Articles of Incorporation and By-laws
If applicant is a Cooperative
1) Certificate of Registration issued by Cooperative Development Authority (CDA)
2) By laws
3) Certificate of Good Standing issued by the CDA
Taxpayer’s Identification Number (copy of card) TIN : _______________________
Current Year General Information Sheet (GIS) submitted and issued by SEC
Passport size picture of the owner/representative
Notarized Application form
Tract record of domestic and export transaction (for Int’l Sugar Trader)
Corporate Income Tax Return (ITR) of the preceding year and Financial Statements
For Trader/Producer of Muscovado whose products are declared as Organic: Certificate issued
by the Organic Certifying Body (OCB) accredited by the Bureau of Agriculture and Fisheries
Product Standards (BAFPS) of the Department of Agriculture (DA):
For Trader/Non-Producer of Organic Muscovado (Traders whose sources of Organic Muscovado
are from Organic Muscovado Producers);
Organic Certificate issued by OCB to Muscovado Producers where the Trader/Non-Producer will
source its muscovado products for sale and distribution.
The certificates issued by the OCB are valid only for one (1) year. For Trader/Producer of
Muscovado whose products are declared as Organic and for Trader/Non-Producer of Organic
Muscovado are required to secure OCB Certificate every year and submit the same to SRA two
(2) months prior to the start of the Crop Year within the validity period of the Certificate of
Registration (or COR) issued pursuant to Muscovado Order No. 2
I HEREBY CERTIFY to the correctness of the above information and I HEREBY AGREE that SRA may
cause the suspension/cancellation or revocation of the LICENSE TO OPERATE or in lieu thereof, the
imposition of a fine for non-observance or violation of its rules/regulations/issuances.
_________________________________
Proprietor/Managing Partner/President
(Signature Over Printed Name)
SUBSCRIBED AND SWORN TO before me this _____ day of ______________________
Affiant exhibited to me his/her Community Tax Certificate No. ___________________________ Issued on
____________________________ at _______________________________________
NOTARY PUBLIC
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UNDERTAKING
KNOW ALL MEN BY THESE PRESENTS:
_____________________________________________________________________________
(Name of Proprietor/Company/Corporation/Cooperative)
With
office
address
and
principal
place
of
business
at
______________________________________________________________________________
hereby
undertakes to faithfully abide and comply with all the Sugar Orders/Circulars/Rules and Regulations and
other issuances of the Sugar Regulatory Administration; to allow SRA authorized representative/s to inspect
my/our warehouse(s)/storage container/s anytime of the day; and that I/We shall be held civilly, criminally
and administratively liable for any violation thereof including payment of damages, if any.
Furthermore, SRA may, for just cause/cancel/revoke/terminate at any time my/our license either
temporarily or permanently.
IN WITNESS WHEREOF, i have hereunto set my hand this _______ day of ___________________ at
_______________________________ , Philippines.
____________________________________________________________
Name of Proprietor/Company/Corporation/Cooperative
(Signature Over Printed Name)
By: __________________________________
Position
(Signature over printed name or person duly authorized for this purpose)
SUBSCRIBED AND SWORN TO before me this _________ day of ______________ affiant exhibited to
me
his/her
Community
Tax
Certificate
No.
_________________________
issued
on
____________________________ at _______________________________ .
NOTARY PUBLIC
FM-REG-LMD-001, Rev.01
Effectivity Date: July 28, 2016
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