Application Form - No-Dollar Importation Of Used Motor Vehicle
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"NOT FOR SALE"
BUREAU OF IMPORT SERVICES
Import Administration Division
rd
3
Floor, OPPEN Bldg., #349 Sen. Gil Puyat Avenue,
Makati City, Metro Manila, Philippines 1200
Tel. Nos. 890-5333 Local 335 / 896-4431
976-5730 loc 3412 / 3405 / 3406 / 3413
Fax Nos. 896-4430 / 976-5758
E-mail address:
Web Page:
APPLICATION FORM
NO-DOLLAR IMPORTATION OF USED MOTOR VEHICLE
(EXECUTIVE ORDER 156)
A. PERSONAL INFORMATION
NAME OF APPLICANT:
DATE OF BIRTH:
CIVIL STATUS:
NATIONALITY:
PASSPORT NO:
IMMIGRANT CARD(I-CARD):
TYPE OF VISA:
LENGTH OF STAY ABROAD:
OCCUPATION:
NAME OF SPOUSE:
FOREIGN ADDRESS:
PHILIPPINE ADDRESS:
CONTACT PERSON:
TEL. NO./FAX NO/E-MAIL ADDRESS:
B. DESCRIPTION OF MOTOR VEHICLE
TARIFF HEADING:
MAKE:
ENGINE DISPLACEMENT (CC):
ENGINE NO.:
COLOR:
YEAR MODEL:
GROSS VEHICLE WEIGHT:
TYPE OF FUEL:
(Not to exceed 3,000 kgs.)
VEHICLE IDENTIFICATION NO.:
DATE OF REGISTRATION:
I hereby declare that the information in this application form are true and correct to the best of my
knowledge and belief, that they are given voluntarily and without fraudulent or deceitful purpose, and that I
am aware that any false statement will make me liable under the provisions of the Revised Penal Code.
_________________________
APPLICANT
(Print complete name and signature)
SUBSCRIBED AND SWORN TO BEFORE ME, this ____ day of _________________, Affiant exhibiting to me
his/her Residence Certificate No. ______________ issued at ______________ on ___________________________.
_________________________
NOTARY PUBLIC
Doc. No. ______
PTR
No. ______
Page No. ______
Valid Until ______
Book No. ______
Series of
______
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