Btrcp Form 16a - Business Name Application Form For Sole Proprietor
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1
2Republic of the Philippines
BTRCP Form No. 16A
Department of Trade and Industry
2011 Edition
(Please read instructions/
BUSINESS NAME APPLICATION FORM
requirements at the back
FOR SOLE PROPRIETOR
before filling up the
application form.)
NEW
RENEWAL
TERRITORIAL SCOPE OF BUSINESS NAME REGISTRATION and FEES (Please tick only one.):
BARANGAY
CITY/MUNICIPALITY
REGIONAL
NATIONAL
P200.00
P500.00
P1,000.00
P2,000.00
(Plus P15 Documentary Stamp Tax pursuant to BIR Rev. Memorandum Order 13-2008 – March 13, 2008)
U N D E R T A K I N G
Per Department Administrative Order (DAO) No. 10-01 as amended, I hereby declare that:
1.
All information supplied in this application are true and correct to the best of my belief and knowledge;
2.
Any false or misleading information supplied, or production of materially false or misleading document to support the application
shall be a ground for the appropriate criminal, civil and or administrative action against me;
3.
I shall voluntarily cancel or change my registered Business Name (BN) upon conclusive determination that a prior registrant and
lawful user of an identical or confusingly similar BN exists. Confusingly similar business names may refer to those enumerated in
item 6 (b) hereof.
4.
I am fully aware of and shall strictly comply with the provision of Act No. 3883, as amended, and its implementing rules and
regulations and other related laws and rules;
5.
I should use my BN to operate a business within six (6) months from its registration with DTI and as such, I shall present LGU
business permit or BIR Certificate of Registration within the said period. If I am an online applicant, I shall also present my ID within
that period.
6.
It is my responsibility to ensure that my proposed business name is -
not and will not be used for business that is illegal, offensive, scandalous, or contrary to propriety (e.g. Popoy’s Jueteng
a)
Betting Place, Boobs Massage and Spa);
b)
not the same or nearly the same as an existing registered business, company, partnership, corporation, cooperative name; nor
it infringes on any trademark, service mark and tradename (e.g. Anne Dok’s Lechon, Jolibee, Starbax Cafe);
c)
not composed purely of generic or geographic words (e.g. The Laundry Shop, Bacolod);
d)
not a name which by law or regulation cannot be appropriated (e.g. OTOP, Intelligence, State College, CALABARZON);
e)
not used to designate or distinguish, or not suggestive of quality of any class of goods, articles, merchandise, or service (e.g.
Best Taho Factory, A-1 Auto Repair Shop );
f)
not a name or abbreviation of a name used by the government in its governmental functions (e.g. NBI Private Investigation
Services, DTI Trading);
g)
not a name or abbreviation of a name of any nation, inter-governmental or international organization (e.g. Philippine Manpower
Pooling Agency, UNESCO Marketing, WHO Health Services); and
not deceptive, misleading or which misrepresent the nature of business (e.g. “ABC Construction Services” where nature of
h)
business is recruitment, a business name carrying another person’s name).
NOTE: Any violation of the above laws and rules will automatically be subject to
CANCELLATION/REVOCATION OF THE BUSINESS NAME.
___________________________________
________________________
OWNER’S Signature over Printed Name
Date
A. Business Details
1. For RENEWAL Application only
Previous Certificate No. :
Business Name :
________________________________________
____________________________________________________________________________________________________________
Owner’s Name
Date of Registration
:
:
2. For NEW Application
st
1
-
Proposed
nd
2
-
Business Names
(in order of priority)
rd
3
-
3. Business Location:
4. TIN
Barangay
City/Municipality
Region
B. Owner’s Details
5. First Name
6. Middle Name
7. Last Name
8. Suffix
(e.g. Jr.,
Sr., I, II)
9. Date of Birth
10. Citizenship
11. Email address
12. Phone no. :
(____)______________
Mobile no. :
C. Owner’s Address
13. House/Building No. & Building name
14. Street
15. Barangay
16. Town/City
17. Province
18. Zip Code
Rec’d by:
Fee:
For DTI Use Only
TRN/PBN
Date Registered Certificate No.
Processed by
Office
OR Number:
Date Paid:
Approved BUSINESS NAME
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