Registration Form

REGISTRATION DATA SHEET GENERAL/BUSINESS/COMPANY RELATIONSHIP INFORMATION

(FOR DOMESTIC COMPANIES ONLY) SEC NUMBER : FILL UP INSTRUCTIONS - Type or print legibly. Light shaded boxes and codes are to be filled up by the SEC, including the SEC number. Check the appropriate boxes. Refer to the back of this form for additional instructions. COMPANY NAME

GENERAL INFORMATION [

] DS - DOMESTIC STOCK

[

COMPANY TYPE ] - DOMESTIC NON-STOCK

[

] DP - DOMESTIC PARTNERSHIP

DATE REGISTERED :

PRINCIPAL OFFICE ADDRESS

AREA CODE

POSTAL CODE

TEL. NO

FAX. NO

POSTAL CODE

TEL. NO

FAX. NO

BUSINESS OFFICE ADDRESS AREA CODE BUSINESS INFORMATION PARTNERSHIP TYPE [ ] L-LIMITED [ ] G-GENERAL

TYPE OF ENTERPRISE

TERMS OF EXISTENCE

INDUSTRY CODE

[ ] - NO SPECIAL REGISTRATION [ ] - E - FIA EXPORT [ ] - D DOMESTIC

FISCAL YEAR END(MM/DD)

[ ] H - FIA-HOLDING [ ] R - FIA REPRESENTATIVE OFF [ ] S - SUBIC REGISTERED [

[ ] F - FINANCIAL INSTITUTION [ ] Z - PEZA-REGISTERED [ ] B - BOI-REGISTERED

ANNUAL MEETING (For domestic companies only) ] F - FIXED (MM/DD) [ ] V - VARIABLE

TOTAL CONTRIBUTION (Of domestic non-stock companies)

TYPE OF NON-STOCK CORPORATION (Refer to the back of this page for the classifications).

% OF FOREIGN MEMBERSHIP (Of domestic non-stock companies) .00%

COMPANY RELATIONSHIPList all companies related to registrant.(Use additional sheets, if necessary) RELATIONSHIP TYPE C - DISSOLVED COMPANY (If due to consolidation) S - PARENT COMPANY (If registrant is a subsidiary) (RELN TYPE) V - DISSOLVED COMPANY (If change in company type) A - AFFILIATE (Of the registrant) RELN TYPE

CERTIFIED CORRECT

SEC NUMBER

: (Signature over printed name)

DATE/TIMESTAMP:

O - OTHERS COMPANY NAME

TIN

POSITION

:

DATE

:

2011/03/17 19:59:04

TIN BIRTHDATE

: :

2011/03/17 19:59:04

APPLICANT’S NAME:

[1] Date Generated :

Thursday Mar 17, 2011 19:59:04

Transaction No. :