Republic of the Philippines DEPARTMENT OF LABOR AND EMPLOYMENT Regional Office No. XII, Koronadal City _______________________________________________________________________________ BWC-ISD-T-5 APPLICATION FOR INTERNAL COMBUSTION ENGINE INSTALLATION 1. Name of Establishment: _____________________________________________ 2. Address: ________________________________________________________ 3. Owner/Manager & His Address: _______________________________________ 4. Where machinery is to be installed: ____________________________________ ________________________________________________________________ 5. Installation permanent or Temporary: ____________________________________ 6. Machinery Data: (a) Name: _______________________________________________________ (b) Type & Model: _________________________________________________ (c) Bore: ________________________ (d) Stroke: _____________________ (e) No. of Cylinder: _______________ (f) Cycle: _____________________ (g) Capacity (HP/kW): _____________ (h) R.P.M.: _____________________ (i) Kind of ICE: __________________ (j) Engine Weight: ______________ 7. Name & Signature of person to supervise the installation: ______________________________________________________________ and ___________________________________________________________ (Board of Mechanical Engineering License, if any) 8. Other Accessories or equipment: ____________________________________ ______________________________________________________________ ___________________________ (Name & Signature of Manager) Tax Identification No________________ Application No.: _______________________ ************************************************************************************************ Note: This application must be accompanied by a foundation and installation plan prepared, signed and sealed by a Professional Mechanical Engineer.
