Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office IV-A

D.O. 174 Online Application

Renew Application

APPLICATION FOR REGISTRATION OF JOB CONTRACTORS/SUBCONTRACTORS

Business Name:

Region:

Province:

City/Municipality:

Barangay:

Address Line 1:

Contact Number: (use comma for multiple contact numbers)

Business TIN:

Email Address:

Re-enter Email Address:

First Name of Contact Person:

Last Name of Contact Person:

Position of Contact Person:

Nature of Business:

Male Workers:

Female Workers:

Total Number of Workers:

Areas of Operation:

Industries to be covered:

Names, Positions and Addresses of Officer and Staff:

First Name	Middle Name	Last Name	Position	Postal Address	Remove

List of Client

Name and Address of Client/Principal	Nature of Business	Services Provided to Clients/Principal	Number of Employees Covered in each phase of the contract		Remove
Name and Address of Client/Principal	Nature of Business	Services Provided to Clients/Principal	Male	Female	Remove

Reminders: Internet speed must be atleast 10mbps for file uploading.

Proof of substantial capital requirement:

Audited financial statement / ITR

Certified true copy of certificate of registration:

Security and Exchange Commission:

Cooperative Development Authority:

Department of Trade and Industry:

If you do not have a Rule 1020 Registration Number, register here: Rule 1020 Registration

DOLE Rule1020 Registration Number:

DOLE Rule1020 Certificate File:

Certified listing with proof of ownership or lease contract of facilities, tools, equipment, premises implements, machineries and work premises, that are actually and directly used by the contractor in the performance or completion of the job, work or service contracted out:

Certificate of Land Title:

Lease Contract:

Photo of the office building and premises where it holds office:

Certified true copy of license or business permit:

Sworn disclosure that the registrant, its officers and owners or principal stockholders have not been operating or previously operating as a contractor under different business name or entity; the list of clients, if any; the number of personnel assigned to each client, if any; and the services provided to the clients:

Clearance Certificate or proof of payments of contributions:

SSS:

PhilHealth:

Pag-IBIG:

BIR:

Semi-annual Report submitted (latest Semester):

Attach old certificate of registration:

Certificate of Pending or No Pending Case issued by DOLE:

Certificate of Pending or No Pending Case issued by NLRC:

Private Security/Agency Service Contract?

Bussines Name:
Bussiness Address:
Region:
Province:
City/Municipality:
Barangay:
TIN:
Telephone Number:
Email Address:
First Name:
Last Name:
Position:
Area of Operation:
Nature of Business:
Industries to be covered:
Male:
Female:
Number of Regular Workers:
Proof of substantial capital requirement:
Security and Exchange Commission:
Cooperative Development Authority:
Department of Trade and Industry:
DOLE Rule1020:
Certified true copy of license or business permit:
Certified listing of facilities, tools, equipment :
Certificate of Land Title:
Lease Contract:
Photo of the office building and premises where it holds office:
Audited financial statement:
Sworn disclosure that the registrant, its officers and owners or principal stockholders have not been operating or previously operating as a contractor under different business name or entity; the list of clients, if any; the number of personnel assigned to each client, if any; and the services provided to the clients.:
Certificate of Membership issued by the Philippine Association of Detective and Protective Agency Operators, Inc. (PADPAO) or other associations recognized by the PNP-CSG-SOSIA:
License to Operate issued by PNP-CSG-SOSIA:

I HEREBY: 1)Certify the truthfulness of the above-mentioned information based on my own personal knowledge and authentic records; 2)Commit to strictly implement the herein attached construction safety and health program designed for this specific project and comply with occupational and health standard required by law; 3)Be responsible for any accident that will happen during the construction, especially for the welfare of the workers who are employed to perform the construction activities; 4)That our company shall abide by all applicable laws and regulations of the Department of Labor and Employment; and 5)That the remittance to SSS, HDMF, Philhealth, ECC and BIR will be paid religiously by the company.

CONSENT NOTICE: The Department of Labor and Employment Regional Office No. IV-A values and is committed to comply with Republic Act No. 10173 otherwise known as the Philippine Data Privacy Act of 2012 (“Data Privacy Act”) to protect and safeguard your privacy. By accomplishing this form, you signify your acceptance to provide pertinent and personal information about you or data establishment. All information that will be collected through this form will be used for the sole purpose of monitoring and fulfilling the functions of this Office. We may only keep your information until such time that we have attained the purpose by which we collect them and when the information is no longer required the DOLE RO IVA procedure will be followed to dispose of said data. Under the foregoing circumstances and to the extent permissible by applicable law. You agree not to take action against DOLE RO IVA for the disclosure and retention of your information.