R.A.

7042
INTERVIEW SHEET

DATE:____________________

1. Name of Applicant : ______________________________________________

2. Business Address : ___________________ Phone No. _________________

3. Residence Address : ______________________________________________

4. Passport No. : ________ Date and Place of Issue _________________

5. Business Activity Applied for and Specific Products/Handled

Activity (Specify if Service Product If for Exports, indicate % &

Manufacturer, Importer, Market for each product
Exporter, Contractor, etc.)

6. Capitalization:

Foreign Currency US$ _________________________

Pesos _________________________
Machinery & Equipment _________________________
(Estimated Valuation)
Other Assets _________________________

Total vvvvvvvvvvvvvvvvvvvvvvvvvvvv

7. Manpower:

Skilled _________________________
Unskilled _________________________
Supervisory _________________________
Others (Specify) _________________________

Total vvvvvvvvvvvvvvvvvvvvvvvvvvvv
8. Remarks : _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

9. Findings :

( ) Qualified
( ) Not Qualified

10. Resident Agent :

Name : ______________________________________________
Address : ______________________________________________

_____________________ ___________
Name & Signature of Date
Representative/Agent

_____________________________
Name & Signature of Interviewer

Conforme:

_____________________ ___________
Name & Signature of Date
Applicant