Application For Registration of Real Estate Broker PDF

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PRLD.0017.

02

Housing and Land Use Regulatory Board


Southern Tagalog Region Field Office
Dencris Business Center, Brgy. Halang
Calamba City, Laguna

APPLICATION FOR REGISTRATION OF REAL ESTATE BROKER


Original (  ) Renewal ( )
Pursuant to Sections 11 and 12 of Presidential Decree No. 957,
As implemented by Board Resolution No. 922, Series of 2014

Name of Applicant: _____________________________________________________________________


Civil Status: _______________ Age: ________ Name of Spouse: _________________________________
Office Address:_________________________________________________________________________
___________________________________________________________ Tel. No.: __________________
Branch Office Address: __________________________________________________________________
___________________________________________________________ Tel. No.:___________________
Residence Address: _____________________________________________________________________
___________________________________________________________ Tel No.: ___________________
Year Last Registered (for renewal only)_________________________________

*Attached herewith are the following:

[ ] Two (2) recent 2 x 2 color photo;


[ ] Photocopy of valid PRC-issued Certificate of Registration and PRC-issued
Professional Identification Card (Originals thereof to be presented upon filing
for comparison as faithful reproduction);
[ ] Photocopy of the Bond or Security (Original copy to be presented upon filing
for comparison as faithful reproduction); and
[ ] Photocopy of the Official Receipt.

Have you ever been convicted of any crime involving a penalty of more than six (6) months
imprisonment? If yes, state the nature:

_____________________________________________________________________
_____________________________________________________________________

_____________________________________
Printed Name and Signature

_________________, ___________________
Place Date

___________________________
T.I.N.

*APPLICATION WITH INCOMPLETE REQUIREMENTS WILL NOT BE ACCEPTED FOR PROCESSING

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