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APPLY FOR ACCREDITATION

Business Information

Business Scope *

Business Name *

Line of Business *

Capitalization *

Region *

Province *

City/Municipality *

Barangay *

Zipcode *

Bldg. No.*

Street Address *

Email address *

Mobile Number *

Telephone Number *

Input Authorized Representative Name*

Pre-Qualification Process

DTI/SEC*

Must be able to issue BIR-Registered receipts and invoices*

Registered under Bureau of Internal Revenue (Please attach file):*

Business Permit*

License to operate as reseller and warehouse by the Fertilizer and Pesticides Authority (FPA)*

If Yes, Please input FPA Registration Number and Proof of
Documents*

Latest Financial Statement*

Article of Incorporation

Financial Details

Are you willing to open an account with DBP?*

Account Type*

PESONET Participating Bank*

Account Number*

Account Name*

For IMC transactions, merchants must have a DBP business bank account. Applicable fees shall be charged for non-DBP business bank accounts*

Has the capacity to provide for the equipment such as phones/tablets operation on Android system, internet connectivity and registered email address, and manpower for facilitating online transactions*

Existing Inventory ( merchant at lease 1 check box here, before to proceed the submission)*

Fertilizer

Pesticides

Seeds

Soil Ameliorant

The merchants understand that DA/DBP/PPI will evaluate your submitted documents*

Do the Merchant comply with the proper storage facility of the above-mentioned inventory*

ACCOUNT INFORMATION

Email *

First Name *

Middle Name

Last Name *

Contact Number *

Region *

Province *

City/Municipality *

Barangay *

Zipcode *

Bldg. No.

Street Address

ACCOUNT REQUIREMENTS

TIN No.

SSS No.

PHIC No.

UPLOAD GOVERNMENT ID

Government ID (maximum of 5mb)

Government specimen signature

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