BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
BFP-QSF-FSED-001 REV.02 (08.24.20)
 PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

BFP-QSF-FSED-001 REV.02 (08.24.20)

 CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

BFP-QSF-FSED-001 REV.02 (08.24.20)

 CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
BFP-QSF-FSED-001 REV.02 (08.24.20) (Region)
(District/Provincial Office)
(Station)
(Station Address)
 (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”
BFP-QSF-FSED-001 REV.02 (08.24.20)
 BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT
BFP-QSF-FSED-001 REV.02 (08.24.20)
 PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC
APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

BFP-QSF-FSED-001 REV.02 (08.24.20)

 FSEC MONITORING (To be filled-up by BFP Personnel only)
CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

BFP-QSF-FSED-001 REV.02 (08.24.20)

 ____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.
BFP-QSF-FSED-001 REV.02 (08.24.20)
 ______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BUREAU OF FIRE PROTECTION

Regional Office 4A
Laguna Provincial Office
Biñan City Fire Station
Brgy. Poblacion, Biñan City, Laguna (049) 511-9111
binanfirestation
@yahoo.com
FSEC APPLICATION NUMBER

FIRE SAFETY EVALUATION CLEARANCE APPLICATION FORM

PROJECT OWNER
PROJECT TITLE
PROJECT LOCATION

OWNER ADDRESS
NAME OF CONTRACTOR/
GENERAL CONTRACTOR
AUTHORIZED REPRESENTATIVE

TOTAL FLOOR AREA (M2) : NO. OF STOREY :

CONTACT NUMBER : EMAIL ADDRESS:

ATTACHED DOCUMENTARY REQUIREMENTS

[ ] THREE (3) COMPLETE SETS OF THE FOLLOWING (PROPOSED PLAN):

[ ] ARCHITECTURAL DOCUMENTS [ ] PLUMBING DOCUMENTS
[ ] CIVIL/STRUCTURAL DOCUMENTS [ ] ELECTRONICS DOCUMENTS
[ ] ELECTRICAL DOCUMENTS [ ] SANITARY DOCUMENTS
[ ] MECHANICAL DOCUMENTS [ ] FIRE PROTECTION DOCUMENTS
[ ] ONE (1) SET OF FIRE SAFETY COMPLIANCE REPORT (FSCR) (IF NECESSARY)
[ ] ONE (1) SET OF COST ESTIMATES OF THE BUILDING INCLUDING LABOR COST SIGNED AND SEALED BY THE
BFP-QSF-FSED-001 REV.02 (08.24.20)
 DESIGNER/CONTRACTOR DULY NOTARIZED
[ ] FIRE SAFETY CLEARANCE FOR WELDING, CUTTING, AND OTHER HOT WORK OPERATIONS (IF REQUIRED)

NOTE: Incomplete documentary requirements will be returned to the applicant.

I hereby certify the correctness of the information provided above and the completeness of the attached documents.

______________________________________________ __________________
OWNER/AUTHORIZED REPRESENTATIVE’S SIGNATURE OVER PRINTED NAME DATE

____________/___________
DATE/TIME

VERIFIED BY BFP-CRO: ____________________________

FSEC MONITORING (To be filled-up by BFP Personnel only)

CRO FCA FCCA C,FSES BPE C,FSES CFM/MFM CRO
DATE: DATE: DATE: DATE: DATE: DATE: DATE: DATE:
IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT IN OUT

PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)

FSEC
BUREAU OF FIRE PROTECTION
(Region)
(District/Provincial Office)
(Station)
(Station Address) (Station Number) (Station Email) APPLICATION NUMBER

CLAIM STUB

CERTIFIED BY:
_______________________ ___________________
CUSTOMER RELATION OFFICER DATE

NOTE: Authorized Representative must present an Authorization Letter and Copy of Owner’s Identification Card
PAALALA: “MAHIGPIT NA IPINAGBABAWAL NG PAMUNUAN NG BUREAU OF FIRE PROTECTION SA MGA KAWANI NITO ANG MAGBENTA O
MAGREKOMENDA NG ANUMANG BRAND NG FIRE EXTINGUISHER”
“FIRE SAFETY IS OUR MAIN CONCERN”

BFP-QSF-FSED-001 REV.02 (08.24.20)