FORM MSLA1a

MASTER SECURITIES LENDING AGREEMENT REGISTRATION FORM

APPENDIX A
DATE

The Commissioner
Bureau of Internal Revenue
National Office Building
Quezon City
Dear Sir:
We are pleased to register with the BIR the attached Master Securities Lending Agreement (MSLA) pursuant to Revenue Regulations No.
________. We certify that the information contained in the MSLA and in this Registration Form are true and correct and conform to the said
Revenue Regulation.

TIN
TITLE/DESIGNATION

(Signature over BORROWERs printed name)

Company

TIN

TIN
TITLE/DESIGNATION

(Signature over LENDER/LENDING AGENTS printed name)

COMPANY

TIN

FOR BIR PERSONNEL ONLY

RECEIVED BY

DATE RECEIVED

REVIEWED BY

DATE OF RELEASE