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8/13/2019 PRPA Form
1/2
Republic of the PhilippinesDepartment of Labor and Employment
Regional Office No. _____
APPLICATION FOR LICENSE TO OPERATE APRIVATE RECRUITMENT AND PLACEMENT AGENC
NAME OF AGENCY: ___________________________________________________________________ADDRE OF AGENCY: ________________________________________________________________
!"N No. ____________________ !E#$FA% Nos. ______________________________________________
T PE OF !USINESS ORGANI"ATION : & Please check '
( ) ole P*op*ieto*ship ( ) Pa*tne*ship ( ) Co*po*ation
Date of Regist*ation: _____________________ Reg. No. ______________________________
COMPRE#ENSIVE DESCRIPTION OF OPERATION$ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ FINANCE$
!otal Assets: _________________________________ +an, tate-ent _____________________________
!otal #iabilities: ______________________________ Date of tate-ent ___________________________
Net o*th: ______________________________________________________________________________
Pai/0in0Capital: _________________________________________________________________________
Date of tate-ent: _______________________________________________________________________
MANAGEMENT AND STAFF$ NAME DE "GNA!"ON ADDRE
"n itness he*eof1 " ha2e he*eunto affi3e/ -4 signatu*e this __________ /a4 of __________________1 56___ in ___________________.
_______________________________________ &Applicant7s Na-e an/ ignatu*e'
8+ CR"+ED AND 9ORN to befo*e -e this ______ /a4 of ______________1 56____ in _________________1
Applicant e3hibiting to -e his$he* Resi/ence Ce*tificate No. _________ issue/ at _______________________ on
_______________________.
NO!ARY P8+#"CDoc. No. __________ Page No. __________ +oo, No. __________
e*ies of __________
8/13/2019 PRPA Form
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List of Requirements for PRPA License
1. Accomplished Application Form,
a. A filing fee of One Thousand Pesos (P1000.00); if single proprietor; and P3,000 ifcorporation or partnership;
. !ertified cop" of the !ertificate of #egistration of firm or usiness name fromthe $epartment of Trade and %ndustr" ($T%), in the case of single proprietorship;or a certified cop" of the Articles of Partnership or %ncorporation dul" registered&ith the 'ecurities and change !ommission (' !), in the case of apartnership or a corporation;
c. A s&orn statement of assets and lia ilities and*or a dul" audited financialstatement, as the case ma" e;
d. O&ner+s certificate*title of office location or contract of lease of office space for
at least t&o ( ) "ears;
e. - % clearance of the applicant, or the partners in the case of a partnership or allthe officers and mem ers of the oard of $irectors, in the case of a corporation;
f. %ncome Ta #eturns for the last t&o ( ) "ears;
g. A /erified underta ing that the applicant shall
(1)not engage in the recruitment of children elo& 12 "ears of age or placechildren elo& 1 "ears old in ha4ardous occupation in accordance &ith#epu lic Act -o. 5610 as amended " #epu lic Act -o. 562 and otherrelated la&s; and
( )assume full responsi ilit" for all claims and lia ilities &hich ma" arise inconnection &ith the use of the license;
h. Organi4ational structure and list of all officers and personnel &ith theirrespecti/e io7data, t&o ( ) passport7si4e %$ pictures and a detailed descriptionof their duties and responsi ilities;
i. 'pecific address and location map of the Office*proposed Office; and 8. 9ist of all authori4ed representati/es, if an", &ho must e at least high school
graduate, &ith their corresponding io7data, t&o ( ) passport7si4e %$ pictures,high school diploma or other proof of educational attainment dul"authenticated, - % clearance and 'pecial Po&er of Attorne" ('PA).
Note No application shall be accepted, unless all the requirements have been compliedwith.