BROKER'S ACCREDITATION FORM

PERSONAL INFORMATION
Name: Nickname:
Residence Address: Tin No.
Birthdate: Birthplace Religion:
Sex: Status: Citizenship:
Tel. No.: Mobile No.: E-mail:
Name of Spouse

LICENSE INFORMATION
PRC License Number: Validity:
HLURB License No.: Validity:
Full Time Broker Part time Broker
Area of Specialization
House & Lots Lots Only Raw Land
Condominium Lease

MEMBERSHIP / AFFILIATION
Organization Position Member Since

LIST OF REQUIREMENTS
Individual Broker: Broker Group:
Broker Accreditaion Form Broker Accreditaion Form
Photocopy of PRC issued REB License Photocopy of PRC issued REB License
Photocopy of HLURB Registration Photocopy of HLURB Registration
BIR Form 2303/BIR Cert. of Reg. BIR Form 2303/BIR Cert. of Reg.
1 pc 1x1 or 2x2 picture 1 pc 1x1 or 2x2 picture
DTI/SEC Registration
ACKNOWLEDGMENT

I hereby certify that all the data stated herein are true and correct.

Broker's Signature over printed name Date:

Received by: Approved by:

_____________________ ________________________________
Sales & Mktg. Assistant Sales & Marketing Head