BLR Form No.5, Series2016 Republic of the Philippines DEPARTMENT OF LABOR AND EMPLOYMENT Regional Office No. ____ APPLICATION FOR REGISTRATION OF CREATION OF LOCAL CHAPTER PART I. INFORMATION ABOUT THE REPORTING ORGANIZATION Date Accomplished (mm/dd/yyyy) To be accomplished by the applicant. Supply all required information. Misrepresentation, false statement or fraud in this application or any supporting document is a ground for denial or cancellation of the legal personality of the local/chapter. Name of Applicant Organization Contact Nos. Address Name of Federation / National Union Contact Nos. Address Charter Certificate No. PaddingDate of Issuance Place of Operation of Union Name of President of Local/Chapter Contact Nos. Name) (M.I.) (Last Name) Address Padding Name of Establishment / Company Industry Classification Coverage of the Bargaining Unit (Pls. Refer to PSC in the TSSD) Address No. of Employees in the Company No. of Employees in the Bargaining Unit No. of Members padding
BLR Form No.5, Series2016 Republic of the Philippines DEPARTMENT OF LABOR AND EMPLOYMENT Regional Office No. ____ APPLICATION FOR REGISTRATION OF CREATION OF LOCAL CHAPTER PART I. INFORMATION ABOUT THE REPORTING ORGANIZATION To be accomplished by the applicant. Supply all required information. Misrepresentation, false statement or fraud in this application or any supporting document is a ground for denial or cancellation of the legal personality of the local/chapter. Date Accomplished (mm/dd/yyyy) Name of Applicant Organization Contact Nos. Address Name of Federation / National Union Contact Nos. Address Charter Certificate No. Place of Operation of Union PaddingDate of Issuance Name of President of Local/Chapter Name) (M.I.) (Last Name) Contact Nos. Address Padding Name of Establishment / Company Address Industry Classification (Pls. Refer to PSC in the TSSD) Coverage of the Bargaining Unit No. of Employees in the Company padding No. of Employees in the Bargaining Unit No. of Members
AF-Certificate%20of%20Creation%20of%20Local%20Chapter.docx