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Mango Flower Inducer Contractor
FPA application form for mango flower inducer contructor
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Annex 22
Form no.
Revision no.
APPLICATION FOR MANGO FLOWER INDUCER
CONTRACTOR
2
Date
09.24.2018
Author
S.A.Binobo
Approved by
J.B.Lansangan
Page
Document title
FPA-FRD-F08
1 of 2
Reminder: Please fill out the form completely and legibly
Attachments:
1. Recommendation from Regional/Provincial Officer
2. License fee of Php1200 (Php600 for Mango Contractors Association member)
3. Mayor’s Permit
4. Certification of Training for Mango Contractor
Date Received
Date Processed
Application No.
Amount Paid
OR Number
OR Date
(to be filled out by FRD)
1.
APPLICANT INFORMATION
:
a. Name
:
b. Address
:
c. Contact number
:
d. Company
:
e. Company Address
f. Capitalization
g. Area of Coverage
:
:
2.
List of Chemicals Used for Flower Induction
3.
Source/Supplier of Chemicals
4.
Equipments used for operation
5.
How long have you been a contractor?
6.
Safety measures employed in handling of fertilizer
7.
Name of personnel with training or experience on application
8.
Place and date of FPA Training
Place
Date
Annex 22
Form no.
Revision no.
APPLICATION FOR MANGO FLOWER INDUCER
CONTRACTOR
2
Date
09.24.2018
Author
S.A.Binobo
Approved by
J.B.Lansangan
Page
Document title
FPA-FRD-F08
2 of 2
CONSENT TO PROCESS AND SHARE DATA
In compliance with the Data Privacy Act, I hereby give my consent to the Fertilizer and Pesticide Authority to share my contact details
to the public for whatever legal purpose it may serve.
Signature over Printed Name of the Applicant
I HEREBY CERTIFY that the foregoing data and information including those in the annexes hereof are true and correct to the
best of my knowledge.
IN WITNESS WHEREOF, I have hereunto set my hand this day of ______year _________ at __________, Philippines.
Name and Signature of the Applicant
REPUBLIC OF THE PHILIPPINES
PROVINCE OF ______________________
MUNICIPALITY/CITY OF ______________
SUBSCRIBED AND SWORN TO before me this _____ day of ________ year _______ at ___________________, Philippines. Affiant
exhibited to me his/her Residence Certificate No. ______________ issued on _________________ at _______________________,
Philippines.
NOTARY PUBLIC
Doc. No.
Page No.
Until
Book No.
PTR NO.
Series of
(Original should bear documentary stamp)
