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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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