PHILIPPINE BUSINESS REGISTRY SEC-REGISTERED COMPANIES APPLICATION FORM

A. SEC REGISTRATION INFORMATION

1. Business Type
Stock Corporation
General Partnership
Foreign Non-Stock Corp
(Please select one.)
Non-Stock Corporation
Limited Partnership
Foreign Partnership
Foreign Stock Corporation Professional Partnership
2. SEC Registration No.
3. SEC Registration Date
4. TIN (pre-generated issued by SEC)

5. Company Name
B. BUSINESS DETAILS
6. House/Building No.
7.

House/Building Name

8.

Street

9.

Barangay

10. Town/City
11. Province

12. Region

13. Phone No.

(Please put in area code)
15. Mobile No.
C. PSIC and Other Details
17. Business Activities
(Please check all that applies)
18. Main Business Activity (Select one among
the business activities you chose above)
19. Indicate Main Product Handled/
Service Rendered
20. Total No. of Employees

14. Fax. No. (Please

put in area code)
16. eMail Address

Manufacturer/Producer
Importer
Manufacturer/Producer
Importer

Service

Retailer

Exporter

Wholesaler

Service
Exporter

Retailer

Wholesaler

D. DOING BUSINESS AS (List down company names and please use another form if more than 5 )

E. INCORPORATOR/PARTNER DETAILS (At least 2 is required. If more than 2 incorporators, use another application form)
MAIN INCORPORATOR/PARTNER
21. Position/Title:
23. Middle name:

22. First Name:

24. Last Name:

25. Suffix:

26. SSS Number:

27. Pag-ibig Number:

28. TIN:
29. House/Building No.
Page 1 of 2

30. House/Building Name

31. Street
32. Barangay
33. Town/City
34. Province

35. Region

PARTNER/OTHER INCORPORATOR
36. First Name:

37. Middle name:

38. Last Name:

39. Suffix:

40. SSS Number:

41. Pag-ibig Number:

42. TIN:
43. House/Building No.
44. House/Building Name
45. Street
46. Barangay
47. Town/City
48. Province

49. Region

F. AUTHORIZED REPRESENTATIVES (At least 1 is required. If more than 2 representatives, use another application form)
Representatives Details
50. First Name:

51. Middle Name:

52. Last Name:

53. Suffix:

54. Telefax Number:

55. Mobile Number:

56. SSS Number

57. Email Address:
Representatives Details
58. First Name:

59. Middle Name:

60. Last Name:

61. Suffix:

62. Telefax Number:

63. Mobile Number:

64. SSS Number

65. Email Address:

_________________________________
OWNERS Signature over Printed Name

________________________
Date

For DTI/SEC-PBR Kiosk Use Only

TRN/ PBN

Date Registered

BIR Tax Identification No.

BN Certificate No.

SSS Employer No.

Office

PhilHealth Employer No.

Page 2 of 2

Fee:

Recd by:

OR Number:

Date Paid:

PAG-IBIG Employer No.