BLR Form No.
4, Series of 2024
This form is NOT FOR SALE
Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. 5
APPLICATION FOR REGISTRATION
(WORKERS’ ASSOCIATION (WAs))
DATA PRIVACY NOTICE: Collection of information such as name, address, contact number and other personal data is necessary to
facilitate your application. By filing a duly accomplished form, you are agreeing to the processing of the collected information consistent
with existing laws, rules and regulations.
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 registration.
Contact Information
Name of Applicant Association E-mail: ________________________________
Landline No: ___________________________
Address Mobile No: _____________________________
Name of President Contact Information
(First Name) (M.I.) (Last Name)
E-mail: ________________________________
Landline No: ___________________________
Address Mobile No: _____________________________
Gender Male Female Others
Padding
Date of CBL Ratification (mm/dd/yyyy)
Date Organized (mm/dd/yyyy)
Occupation of Members. Please check appropriate category. No. of Association Members
Agricultural Workers Male
( Farmers Fisher folk Artisans Cottage Others _________________ ) Female
Transport Workers
TOTAL
(Drivers: Jeepney FX Tricycle Pedicab Bus Others _________)
Home-based / Homeworkers
Please specify economic activity __________
Construction Workers
Vendors
( Market Sidewalk Ambulant Others _________________)
Miners
Others, Please specify
____________________________________________________________
I attest to the truth of the foregoing.
________________________________________________
President
(Signature over printed name)
Subscribed and sworn to before me at ___________________________________________________, Philippines,
this _______ day of _________________ 20 _______ with I.D. No. _________________________________________
issued by ___________________________________________________ on _________________________________.
NOTARY PUBLIC
Doc. No. __________
Page No. __________
Book No. __________
Series of __________
BLR Form No. 4, Series of 2024
This form is NOT FOR SALE
Padding
PART II. PROCESSING OF REQUIREMENTS Date Received(mm/dd/yyyy)
(WORKERS’ ASSOCIATION)
A. CHECKLIST. ALL DOCUMENTS MUST BE CERTIFIED CORRECT BY THE SECRETARY OR
TREASURER, AS THE CASE MAYBE, AND ATTESTED TO BY THE PRESIDENT OF THE
WORKERS’ ASSOCIATION.
Duly accomplished application form shall be accompanied by the original copy and two (2) duplicate original
copies of the following documents (Section 2-C, Rule III of D.O. 40-03, as amended):
1. Duly filled-up notarized Application Form
2. Names of the applicant association’s officers and their respective addresses
3. Minutes of the organizational meeting/s
4. List of members who participated in the organizational meeting/s
5. Annual financial reports if applicant has been in existence for one or more years
Certification that the applicant association has not collected any amount from the members
6. Constitution and By-laws
7. Minutes of adoption or ratification of the CBL and date/s when ratification was made
CBL was ratified or adopted during the organizational meeting/s and such fact is reflected in the minutes of
organizational meeting/s
8. Names of members who participated in the ratification of CBL
List of ratifying members is included in the list of members who participated in the organizational
meeting/s
9. Registration Fee
B. RECOMMENDATION ON THE APPLICATION:
Recommending Approval with Registration Certificate No.
Recommending Denial due to failure to comply with documentary requirements (Refer to Denial letter for the
lacking documents)
By: MICHAEL S. ALBAÑO
Processor
(Signature over printed name)
Date: _________________
PART III. ACTION ON THE APPLICATION
A. APPROVAL / DENIAL
Respectfully endorsed to the Approving Authority
Recommending Approval of the Certificate of Registration
Recommending Denial due to failure to comply with documentary requirements
MICHAEL S. ALBAÑO _______________
WA Focal Date
(Signature over printed name)
