Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE

CIVIL SECURITY GROUP

Firearms and Explosives Office

Camp Crame, Quezon City

PRE-EVALUATION FORMS

License to Manufacture, Deal and Purchase Controlled Chemicals

MANUFACTURER DEALER PURCHASER (AMENDMENT)

Applicant (Company): ___Contact Person:

Address of Storage Facility: Contact No:

REQUIREMENTS

REMARKS

a. Duly accomplished Application Form;

b. In case of additional controlled chemicals:

1) Process flowchart;

2) Material Safety Data Sheet (MSDS)/Safety Data Sheet (SDS) of the controlled chemicals to be provided by the supplier; and

3) For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from Chief, EEMD, FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the RCSU or the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU.

c. In case of increase in quantity of controlled chemicals and/or establishment of additional storage facility:

a. Notarized latest Monthly Consumption Report;

b. Properly labeled pictures (8”x10” in size) of the additional storage facility printed in photo paper; and

c. For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from Chief, EEMD, FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the RCSU or the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU. where the controlled chemicals will be stored;

d. In case of change of storage facility:

1) Duly accomplished Application Form;

2) Business Permit;

3) Vicinity map of the factory and storage facility showing distance from the nearest Police Headquarters;

4) Floor/Location plan of the storage facility;

5) Properly labeled pictures (8”x10” in size) of storage facility printed in photo paper;

6) For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from Chief, EEMD, FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the RCSU or the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU.

d. In case of change of corporate/business address:

1) For local Corporation or Partnership: Certificate of Registration of the firm with the SEC to include its machine validated Article of Incorporation and GIS.

For Foreign Multi-corporation: SEC Registration to do business in the Philippines.

For Single Proprietorship: Certificate of Registration with DTI.

2) Business Permit;

3) Vicinity map of the factory and storage facility showing distance from the nearest Police Headquarters;

4) Floor/Location plan of the storage facility;

5) Properly labeled pictures (8”x10” in size) of storage facility printed in photo paper; and

6) For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from the Chief, EEMD FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the Regional Civil Security Unit or from the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU.

d. In case of change of corporate/business name:

For Corporation or Partnership: Certificate of Registration of the firm with SEC to include its machine validated Article of Incorporation and GIS;

For foreign multi-corporation – SEC Registration to do business in the Philippines.

For Single Proprietorship: Certificate of Registration with DTI.

Received by:

Note: The PDS and NBI clearance of the applicant shall be submitted if the applicant for amendment of license is different from previous application

EXPLOSIVES/EXPLOSIVE INGREDIENTS/ CONTROLLED CHEMICALS

QUANTITY APPLIED

QUANTITY RECOMMENDED BY FEO

INCREASE OF QUANTITY:

1. AMMONIUM NITRATE 99%

10 KGS

10 KGS

2. ELTRA MAGNESIUM PERCHLORATE 83%

10,896 GRMS

10,896 GRMS

3. COPPER II NITRATE >=0,25%-<1%

60,000 ML

60,000 ML

4. CUPRIC NITRATE 2.4/97.6 %

60,000 ML

60,000 ML

5. NICKEL II NITRATE<=100%

7,500 ML

7,500 ML

xxx

xxx

xxx

(AMENDMENT SAMPLE FORMAT)

PREVIOUS ADDRESS

NEW/PRESENT ADDRESS

CHANGE OF EXPLOSIVES CORPORATE ADDRESS

Rizal PPO Compound, Bo. Kaytikling, Taytay, Rizal

A.C. Equities Inc., Sitio Hapay na Mangga, Brgy. Dolores, Taytay, Rizal

xxx

xxx

xxx

EXPLOSIVES/EXPLOSIVE INGREDIENTS/ CONTROLLED CHEMICALS

QUANTITY APPLIED

QUANTITY RECOMMENDED BY FEO

TO BE DELISTED IN THE LICENSE:

1. AMMONIUM NITRATE 99%

10 KGS

10 KGS

2. ELTRA MAGNESIUM PERCHLORATE 83%

10,896 GRMS

10,896 GRMS

3. COPPER II NITRATE >=0,25%-<1%

60,000 ML

60,000 ML

4. CUPRIC NITRATE 2.4/97.6 %

60,000 ML

60,000 ML

5. NICKEL II NITRATE<=100%

7,500 ML

7,500 ML

xxx

xxx

xxx

EXPLOSIVES/EXPLOSIVE INGREDIENTS/ CONTROLLED CHEMICALS

QUANTITY APPLIED

QUANTITY RECOMMENDED BY FEO

TO BE RETAINED IN THE LICENSE:

1. AMMONIUM NITRATE 99%

10 KGS

10 KGS

2. ELTRA MAGNESIUM PERCHLORATE 83%

10,896 GRMS

10,896 GRMS

3. COPPER II NITRATE >=0,25%-<1%

60,000 ML

60,000 ML

4. CUPRIC NITRATE 2.4/97.6 %

60,000 ML

60,000 ML

5. NICKEL II NITRATE<=100%

7,500 ML

7,500 ML

xxx

xxx

xxx

TO BE INCLUDED IN THE AMENDED LICENSE:

Eleven (11) Explosives/Explosive Ingredients/accessories (blasting materials) with their Authorized Quantities previously approved under a valid PURCHASER’S LICENSE NO. P31404-2985.

1. DYNAMITE

1,500 CS

2. ORD BLASTING CAP

10,000 PCS

3. ELEC BLASTING CAP

5,000 PCS

4. SAFETY FUSE

20,000 MTRS

5. DETONATING CORD

150,000 MTRS

6. SPITTER CORD

5,000 MTRS

7. CONNECTOR

10,000 PCS

8. NIT PRIMER

5,000 PCS

9. AMMONIUM NITRATE

156,000 KGS

10. SLURRY POWDER

84,000 KGS

11. FUSE LIGHTER

1,000 PCS

xxx

xxx

EXPLOSIVES MANAGEMENT DIVISION

License to Manufacture, Deal and Purchase Controlled Chemicals

MANUFACTURER DEALER PURCHASER (AMENDMENT)

a. Duly accomplished Application Form;

b. In case of additional controlled chemicals:

1) Process flowchart;

2) Material Safety Data Sheet (MSDS)/Safety Data Sheet (SDS) of the controlled chemicals to be provided by the supplier; and

3) For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from Chief, EEMD, FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the RCSU or the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU.

c. In case of increase in quantity of controlled chemicals and/or establishment of additional storage facility:

1) Notarized latest Monthly Consumption Report;

2) Properly labeled pictures (8”x10” in size) of the additional storage facility printed in photo paper; and

3) For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from Chief, EEMD, FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the RCSU or the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU. where the controlled chemicals will be stored;

d. In case of change of storage facility:

1) Duly accomplished Application Form;

2) Business Permit;

3) Vicinity map of the factory and storage facility showing distance from the nearest Police Headquarters;

4) Floor/Location plan of the storage facility;

5) Properly labeled pictures (8”x10” in size) of storage facility printed in photo paper;

6) For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from Chief, EEMD, FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the RCSU or the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU.

e. In case of change of corporate/business address:

1) For local Corporation or Partnership: Certificate of Registration of the firm with the SEC to include its machine validated Article of Incorporation and GIS.

For Foreign Multi-corporation: SEC Registration to do business in the Philippines.

For Single Proprietorship: Certificate of Registration with DTI.

2) Business Permit;

3) Vicinity map of the factory and storage facility showing distance from the nearest Police Headquarters;

4) Floor/Location plan of the storage facility;

5) Properly labeled pictures (8”x10” in size) of storage facility printed in photo paper; and

6) For Metro Manila applicants: Security Survey Inspection Report from the Chief of Police of the concerned Police Station and Certificate of Inspection from the Chief, EEMD FEO.

For outside Metro Manila applicants: Security Survey Inspection Report from the Provincial Director, PPO/City Director, CPO and Certificate of Inspection from the Regional Civil Security Unit or from the Provincial Director, PPO/City Director, CPO pending full activation of the RCSU.

f. In case of change of corporate/business name:

For Corporation or Partnership: Certificate of Registration of the firm with SEC to include its machine validated Article of Incorporation and GIS;

For foreign multi-corporation – SEC Registration to do business in the Philippines.

For Single Proprietorship: Certificate of Registration with DTI.

Note: The PDS and NBI clearance of the applicant shall be submitted if the applicant for amendment of license is different from previous application

Applicant (Company): ___Contact Person:

Address of Storage Facility: Contact No:

RECEIVER/VERIFIER

Received Date: ___________ 2017 Time: _______ AM/PMReleased Date: ___________ 2017 Time: _______ AM/PM

Signature above printed name:

Chief, License and Permit Section

Received Date: ___________ 2017 Time: _______ AM/PM

Released Date: ___________ 2017 Time: _______ AM/PM

CIELO L CALIGTAN

Police Chief Inspector

Chief, EMD

Received Date: ___________ 2017 Time: _______ AM/PM

Released Date: ___________ 2017 Time: _______ AM/PM

CONRADO P GONGON, JR.

Police Senior Superintendent

Recommend Approval: Chief, FEO

Received Date: ___________ 2017 Time: _______ AM/PMReleased Date: ___________ 2017 Time: _______ AM/PM

CESAR HAWTHORNE R BINAGPolice Chief Superintendent

Approved: D, CSG

Received Date: ___________ 2017 Time: _______ AM/PMReleased Date: ___________ 2017 Time: _______ AM/PM

FEDERICO L DULAY JRPolice Director