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LTFRB Operators Data Sheet

This document is an operator data sheet from the Department of Transportation and Communications for a land transportation franchise. It collects information such as the operator name, type of ownership (individual, corporation, etc.), contact details, franchise details, and an attestation by the operator that the information provided is true and correct. The data sheet aims to gather essential information about transportation operators applying for or holding franchises to provide public transportation services.

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Kleng Kleng
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© © All Rights Reserved
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5K views

LTFRB Operators Data Sheet

This document is an operator data sheet from the Department of Transportation and Communications for a land transportation franchise. It collects information such as the operator name, type of ownership (individual, corporation, etc.), contact details, franchise details, and an attestation by the operator that the information provided is true and correct. The data sheet aims to gather essential information about transportation operators applying for or holding franchises to provide public transportation services.

Uploaded by

Kleng Kleng
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Department of Transportation and Communications

LAND TRANSPORTATION FRANCHISING AND REGULATORY BOARD


East Avenue, Quezon City

PASTE
OPERATOR DATA SHEET
2X2 PHOTO

TYPE OF OWNERSHIP Single Proprietorship Corporation

Partnership Cooperative

I. CASE NUMBER______________ NO. OF AUTHORIZED UNITS ___________


TYPE OF SERVICE PUJ SB AUV

TH TX PUB ___ AC ____REG

TTS SHS

NO. EXISTING FRANCHISE_________________________________________

CASE NUMBER NO.OF AUTHORIZED UNITS

NO. OF PENDING APPLICATIONS__________________________________

CASE NUMBER TYPE OF APPLICATION


II. FOR INDIVIDUAL OPERATOR:

LAST NAME______________________________________________________
FIRST NAME_____________________________________________________
MIDDLE NAME____________________________________________________

DATE OF BIRTH__________________SEX: F M
TIN NO._________
BUSINESS ADDRESS______________________________________________
MAILING ADDRESS_______________________________________________
PHONE NUMBER_________________________________________________
E-MAIL__________________________________________________________

SPECIMEN SIGNATURE

III. FOR CORPORATION/COOPERATIVE/OTHERS

NAME OF CORPORATION/COOPERATIVE/OTHERS____________________
________________________________________________________________
SEC/CDA REGISTRATION NO. ________________TIN NO._______________
BUSINESS ADDRESS______________________________________________
MAILING ADDRESS_______________________________________________
PHONE NUMBER_________________________________________________
E-MAIL__________________________________________________________

IV. Authorized Representative [Note: Only the authorized representative identified


in this sheet will be allowed to transact business in the agency for and on behalf
of the owner]

LASTNAME______________________________________________________
FIRST NAME_____________________________________________________
MIDDLE NAME____________________________________________________
DATE OF BIRTH_______________SEX M F TIN NO.___________
BUSINESS ADDRESS______________________________________________
MAILING ADDRESS_______________________________________________
PHONE NUMBER_________________________________________________
E-MAIL__________________________________________________________

Operator undertakes that all information stated in this sheet are true and correct.
Any misrepresentation and/or unlawful withholding of information will warrant
outright denial and/or cancellation of the franchise in accordance with the Public
Service Act. The Board reserves the right to VERIFY all information in this
datasheet and to institute appropriate criminal prosecution for any act prejudicial
to the public interest.
ATTESTATION AND UNDERTAKING

I,_________________________________, do hereby ATTEST that the


foregoing information are complete, true and correct to the best of my knowledge
and belief. I commit to inform the Board in writing any subsequent changes in
this data sheet within 15 days from knowledge thereof.

_______________________________
Signature over Printed Name

SUBSCRIBED AND SWORN TO before me this __________________, a


notary public for and in the city of _________________________________, the
affiant showing to me his/her identification card with
no.________________________.

NOTARY PUBLIC

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