9th Floor, Ortigas Building, Ortigas Avenue, Pasig City, 1600, Metro Manila

Telephone Nos. (632) 631 - 1231 to 38 Fax No. (032) 631 – 6517

INTERNATIONAL MARKETING PARTNER

ACCREDITATION FORM
PERSONAL BACKGROUND
LAST NAME FIRST NAME MIDDLE NAME NICKNAME

DATE OF BIRTH (MM/DD/YYYY) GENDER MARITAL STATUS CITIZENSHIP

PERMANENT/MAILING ADDRESS

EMAIL ADDRESS MOBILE PHONE OTHER CONTACT NO.

PERSON TO NOTIFY IN CASE OF EMERGENCY RELATIONSHIP CONTACT NO./ADDRESS

PROFESSIONAL DATA
TYPE OF ACCREDITATION: Individual Broker Mar keting Partner (Local)
(please check) Broker Company Marketing Partner (International)
BROKER/COMPANY NAME (IF APPLICABLE) BUSINESS ADDRESS

BROKER’S/SALESMAN’S LICENSE NO. AND EXPIRY DATE SEC REGISTRATION NO. (FOR BROKER COMPANY ONLY) VAT NUMBER

SOCIAL SECURITY (SSS) NO. TAX IDENTIFICATION (TIN) NO. BROKER ORGANIZATION AFFILIATION

OTHER DEVELOPER(S) ACCREDITED/AFFILIATED WITH

REAL ESTATE COMPANY POSITION INCLUSIVE DATES STATUS (Active/Inactive)

SIGNATURE OVER PRINTED NAME DATE SIGNED

ACCREDITED BY: (to be filled up by an Ortigas & Company employee/representative)

COMPANY EMPLOYEE/REPRESENTATIVE POSITION DATE SIGNED/ACCREDITED SIGNATURE

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 REMITTANCE INSTRUCTION
FOR INTERNATIONAL MARKETING PARTNER

NAME OF IMP:
Attach copy of PASSPORT for verification.

REMITTANCE OPTIONS (choose only one):

• WIRE TRANSFER (International bank account subject to applicable bank charges)

Account Name:
Beneficiary Address:

Account Number:
Bank Name:
Bank Address:
SWIFT Code:
ABA Routing:

• LOCAL BANK DEPOSIT

Bank Name:
Bank Address/Branch:

Bank Account Name:

Bank Account No.:

I hereby authorize Ortigas and Company, Limited Partnership, its subsidiaries, affiliates,
partners, successors and/or assigns (the “Ortigas Group”) to collect, process, store, and use
any and all information that I furnish the Ortigas Group for the purpose of processing any
commission and marketing fees that may be due to me. I hereby expressly and knowingly
waive any and all statutory or regulatory provisions governing the confidentiality of such
information, if applicable.

IMP's Signature:

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