Republic of the Philippines

Department of Finance
SECURITIES AND EXCHANGE COMMISION
Metro Manila

STATEMENT OF ASSETS AND LIABILITIES

as of , 2000
at
with office at

EXAMINED AND FOUND IN ORDER FOR PURPOSES OF

INCORPORATION, IS HEREBY PUBLISHED UNDER
SECTION 9 OF ACT 1486 BY ORDER OF THE
SECURITIES AND EXCHANGE COMMISION

ASSETS
Cash on hand / or in banks P
Accounts receivable

Furniture and Office Equipment

Total Assets P

LIABILITIES AND NET WORTH

Accounts payable P

Total Liabilities P

Authorized Capital Stock :

shares
( Number ) ( Class )

at P par value P
Capital Stock Subscribed
Less : Subscription Receivable P
Paid-up Capital
Surplus
Net Worth
P
Total Liabilities & Net Worth

TREASURER
REPUBLIC OF THE PHILIPPINES )
) S.S.

SUBSCRIBED AND SWORN to before me this day of

, affiant having exhibited to me his / her Residence Certificate Number :
issued at on , .

Doc. No.
Page No.
Book No.
Series of 2000

NOTARY PUBLIC
Until December 31 , 2000