Retail Form

Business Verification

Email* FV Name* Applicant's Name* Business Name* Trade Name* Business Address* Contact No./Business Email Address* Other Contact No.* Ownership*

CorporationPartnershipSingle/Sole Proprietorship

Business Registration*

SECDTICity PermitBIR

Ownership%* Date Established* Nature of Business*

Manufacturing: Producing goods or productsRetail: Selling goods directly to consumersService: Providing Services rather than tangible goodsTrading: Buying and selling goodsTechnology: Developing and offering technological solutionsother

Years of Operation* Operating Hours* Operating Days* Product* Main Line of Business* Total No. Employees* Regular Employees* Contractual Employees* Gross Annual / Monthly Income Directory/On-line Listed* Premises

OwnedLeasedUsed FreeRentedNo information

Premises Monthly Rental Customer's Name / Address / Contact Person / Tel. Nos. (At least 3)* Supplier's Name / Address / Contact Person / Tel. Nos. (At least 3)* Loans Name of Bank / Branch / Account Type / Account No. Vehicles Owned (business) / Condition / Mortgage to / Remarks* Branch / Affiliates / Address Business Activity*

BriskSlowModerate

Product/Service*

SalableSlow

Signboard

WithWithout

Location

GoodPoor

Inventory*

HighAdequateLow

Area Classification*

ResidentialCommercialIndustrial

CI Result*

Verified OKVerified with AdverseNot VerifiedNon Existent

Informant Remarks* Other Info / Remarks* Time of Visit*

Picture of Structure (Left Side, Front, Right Side)*

Attach left side, front, and right side photos.

Street View (Left, Front, Right)*

Attach left side, front, and right side photos.

Picture of Barangay Hall*

Picture of Business Activity

Attach Business Activity

Product / Inventory*

Attach product and inventory photos.

Additional Picture

Permits*

Attach all relevant permits (e.g., Business Permit, DTI/SEC Registration, BIR Certificate of Registration).

Call log History

Other

Attach any additional supporting photos or documents.

Section

ANTI-SUHOL REPORT

Report within 24 hours if you have experienced any form of bribery in kind or in cash while you were conducting verification.

Did you experience any type of bribery? (Material / Food / Money / Favors) Report the incident and any unlawful activities encountered.*

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