REPUBLIC OF THE PHILIPPINES Reference Number:

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 2020-0007-1084

OFFICE OF THE ADMISSION SERVICES Scheduled Date of Online Credential Processing,
STA. MESA, MANILA Interview, and Enrollment:
JUL 1 2020 8:00AM
SAR-FORM 1 FIRST-COME-FIRST-SERVED basis subject to the
availability of slots
WITH CONFIRMATION DOCUMENTS .

Confirmation Slip (For a 4 or 5-year degree, or 3-year diploma program)

This University Admission Committee Attach

recent 2x2" photo
here
BANAYAT, MIA MONETTE MENDEZ
I am _________________________________________________________________________________________________________________________

73 and graduated in ______________________________

who obtained a PUPCET Score of ____________ SY 2019-2020
VALLEY HIGH ACADEMY
from ________________________________________________________________________________________________________________________________________________________________
would like to confirm my interest to be interviewed, admitted, and enrolled this First Semester, Academic Year 2020-2021 in a program where I am qualified
based on the Specific College Criteria.

I understand that my admission in the University shall be based on passing the interview and satisfying the University or college requirements on a
FIRST-COME-FIRST-SERVED basis subject to the availability of slots on the scheduled dates of enrollment according to PUPCET Score/Percentile
Rank. By signing this document, I hereby agree to the terms and conditions stated above.

Respectfully yours,

BANAYAT, MIA MONETTE MENDEZ

Signature over Printed Name of Applicant Note: Read carefully the freshman admission and enrollment procedure


REPUBLIC OF THE PHILIPPINES Reference Number:
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 2020-0007-1084
OFFICE OF THE ADMISSION SERVICES Scheduled Date of Online Credential Processing,
STA. MESA, MANILA Interview, and Enrollment:
JUL 1 2020 8:00AM
SAR-FORM 1 FIRST-COME-FIRST-SERVED basis subject to the
availability of slots
WITH CONFIRMATION DOCUMENTS .

Confirmation Slip (For a 4 or 5-year degree, or 3-year diploma program)

This University Admission Committee Attach

recent 2x2" photo
here
BANAYAT, MIA MONETTE MENDEZ
I am _________________________________________________________________________________________________________________________

73 and graduated in ______________________________

who obtained a PUPCET Score of ____________ SY 2019-2020
VALLEY HIGH ACADEMY
from ________________________________________________________________________________________________________________________________________________________________
would like to confirm my interest to be interviewed, admitted, and enrolled this First Semester, Academic Year 2020-2021 in a program where I am qualified
based on the Specific College Criteria.

I understand that my admission in the University shall be based on passing the interview and satisfying the University or college requirements on a
FIRST-COME-FIRST-SERVED basis subject to the availability of slots on the scheduled dates of enrollment according to PUPCET Score/Percentile
Rank. By signing this document, I hereby agree to the terms and conditions stated above.

Respectfully yours,

BANAYAT, MIA MONETTE MENDEZ

Signature over Printed Name of Applicant Note: Read carefully the freshman admission and enrollment procedure
 ADMISSION AND ENROLLMENT
ACADEMIC YEAR 2020-2021

BANAYAT, MIA MONETTE MENDEZ

Name of Applicant: _________________________________________________________________________________________________________________________
2020-0007-1084
Reference Number: ______________________________________________ JUL 1 2020 8:00AM
Date of Enrollment: _____________________________________________________
ACCOUNTANCY, BUSINESS AND MANAGEMENT
SHS Track/Strand: _________________________________________________________________________________________________________________________

Note: Read carefully the Freshman Admission and Enrollment Procedure

1. Online Confirmation
1.1. Download this Confirmation Slip
1.2. Submit the following documents upon enrollment:

1.2.1. Required Credentials:

Enrollee must submit the original copy and photocopies of the following documents to the Admission and Registration
Services Section on or before the Mid-Term Examination (October 15, 2020) of the First Semester, A.Y. 2020-2021 personally or
thru courier:
PUP Admission Services
G/F Room 117 East Wing Main Building
Anonas St., Brgy 630, Sta. Mesa, Manila 1016

For Graduating Senior High School Student

a) Original or certified true copy of grade 10 & 11 high school card.
b) Original Senior High School Card (F138) with school dry seal.
c) Notarized certification of non-enrollment for high school/senior high school graduates who have not enrolled
in any technical/diploma/degree program immediately after graduation.
d) Certificate of Completion for high school/ senior high school.
e) Original PSA Birth Certificate.
f) Certification of Good Moral issued by the HS/SHS Principal/or Guidance Counselor with school dry seal.
g) School ID (for currently enrolled students) or any valid ID with picture (for previous SHS graduates)
h) Duly signed Waiver/Certification Under Oath. (Waiver is attached in this Confirmation Slip)
i) PUP Medical Health Information Sheet for Student. Do not leave any item unanswered and send to
medical@pup.edu.ph
j) Two (2) pcs of 2x2 inches colored picture with white background and with the applicant's name on the photo.
k) One (1) pc. long brown envelope

For Senior High School Graduates/High School Graduates of Past School Year/s
In addition to the above admission requirements:
l) Certification from the respective senior high school registrar with school dry seal and noted by the Principal that no
copy of F137A has been sent to other college or university.
m) Notarized certification of non-enrollment in any technical/diploma/degree program immediately after graduation
with "waiver" that if there is concealment of previous enrollment, PUP enrollment becomes null and void.

1.2.2. Other Requirements:

For applicants whose Senior High School English final grade is below 80%, you will be scheduled to take the English
Placement Test (EPT). A fee of P150.00 for the English Placement Test shall be paid to the PUP Cashier.

1.3. Download the College Admission Criteria and see which program fits your interest and will qualify you. (College Admission
Criteria is attached in this Confirmation Slip)

2. Online Enrollment
See the schedule of Online Enrollment in this Confirmation Slip. Please make yourself available during the specified schedule of
Online Enrollment. Admission to PUP is on a first come first served basis.

3. Downloading and Printing of Registration Card

See the schedule of downloading and printing of Registration Card upon Online Enrollment.

These documents contain personal-identifiable information that is subject to Data Privacy.

Please keep these documents protected and in a safe place.
 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
Office of the Vice President for Administration
MEDICAL SERVICES DEPARTMENT

HEALTH INFORMATION SHEET FOR STUDENT

Do not leave any item unanswered and send to medical@pup.edu.ph
PART I. STUDENT INFORMATION
Name: Date:
Address: School Year:
Age: Sex: Civil Status: Course / College:
Blood Type:
Parent's Name / Guardian:
Landline: Cellphone:

PART II. MEDICAL HISTORY

1. Do you need medical attention or has known medical illness? ⬜ No ⬜ Yes
(Please check the following that apply and give more information as needed)
⬜ Asthma ⬜ Fainting ⬜ Vision Problems ⬜ Hearing Problems
⬜ Diabetes ⬜ Heart Condition ⬜ Kidney Disease ⬜ Hearing Problems
⬜ Seizure Disorder ⬜ Hyperventilation ⬜ Hemophilia ⬜ Muscle Weakness/Paralysis
⬜ Migraine ⬜ Hypertension
⬜ Others (Pls. Indicate):

2.Previous Hospitalization: ⬜ No ⬜ Yes Year:

Operation/Surgery: ⬜ No ⬜ Yes Year:

3. Additional Information for Students with Medical Conditions:

As a Parent/Guardian, I would like to declare that my child/ward had history of allergies to the following:
Food:
Medicines:

PART III. FAMILY HISTORY

⬜ Diabetes ⬜ PTB ⬜ Hypertension ⬜ Cancer
⬜ Others (Pls. Indicate):

PART IV. PERSONAL HISTORY

Cigarette Smoking: ⬜ Yes ⬜ No
Alcohol Drinking: ⬜ Yes ⬜ No
Do you feel stressed: ⬜ Yes ⬜ No

I hereby state to the best of my knowledge, my answers to the above questions are complete and correct.

By affixing my signature (Parent/Guardian), I am agreeing to the PUP Data Privacy Policy and giving my consent
in the collection and processing of the student's name above his/her Personal Information in accordance thereto
and be given medical and dental care by the PUP physician/Dentist.

Signature of Parent/Guardian Signature of Student Date

Due to Community Quarantine, please be informed that Physical Examination for enrollment and submission
of chest x-ray is temporarily deferred until further notice.
 --- TO BE FILLED-UP BY PUP PHYSICIANS ---
V. PHYSICAL EXAMINATION
Vital Signs: ⬜ Not in Distress ⬜ In Distress

Ht. Wt. Kg. BMI:

BP HR /min RR: /min Temperature:

Head: ⬜ Wound ⬜ Mass ⬜ Alopecia

Eyes: ⬜ w/o Glasses ⬜ w/ Glasses ⬜ Anicteric Sclera ⬜ Pink Palpebral Conjunctiva
Ears: ⬜ No Gross Deformity ⬜ No Discharge
Throat: ⬜ No TPC ⬜ No Mass ⬜ No lymphadenopathy
Chest/Lungs: ⬜ Normal ⬜ Wheeze ⬜ Rales
Breast: ⬜ Normal
Heart: Murmur:⬜ Present ⬜ Absent Rhythm: ⬜ Regular ⬜ Irregular
Abdomen: ⬜ Normal
Genito-Urinary: 1st day of last Menstruation:
Extremities: ⬜ No Deformities ⬜ Yes (Pls. Indicate)
Vertebral Column: ⬜ Normal ⬜ With Deformity
Skin: ⬜ Pallor ⬜ Rashes ⬜ Lesions Scars: ⬜ Absent ⬜ Present

IMPRESSION:

Fit:

For Work-Up:

Referred to:
⬜ Cardio ⬜ Pulmo ⬜ ENT
⬜ Derma ⬜ Optha ⬜ Others:

Follow up on:

Physician's Signature:

Date:
PHYSICIANS NOTES
REPUBLIC OF THE PHILIPPINES )
CITY OF MANILA ) S.S. FORM 1

CERTIFICATION UNDER OATH

I, _________________________________, of legal age, Filipino, with residence and postal address

at ______________________________________________________________ having been duly sworn to in
accordance with the law, do hereby depose and say THAT:

1. I am an enrollee of Polytechnic University of the Philippines (PUP), (Please check one:

 Sta. Mesa Manila /  Branch _________________________ (state the Branch/Campus);
2. In compliance with the documentary requirements of the aforementioned University,
among others, I am submitting the following documents within the First Semester,
Academic Year 2020-2021 on or before the Mid-Term Examinations on October 15, 2020:
a. Original or certified true copy of grade 10 & 11 high school card.
b. Original Senior High School Card (F138) with school dry seal.
c. Notarized certification of non-enrollment for high school/senior high school graduates who have
not enrolled in any technical/diploma/degree program immediately after graduation.
d. Certificate of Completion for senior high school.
e. Original PSA Birth Certificate.
f. Certificate of Good Moral issued by the SHS Principal/or Guidance Counselor with school dry seal.
g. School ID (for currently enrolled students) or any valid ID with picture (for previous SHS graduates)
h. Duly signed Certification Under Oath, Form 2
i. Two (2) pcs. 2 in. x 2 in. colored picture with white background with applicant's name on the photo.
j. One (1) pc. long brown envelope.
For Senior High School Graduates/High School Graduates of Past School Year/s
In addition to the above admission requirements:
a. Certification from senior high school registrar with school dry seal and noted by the Principal that
no copy of F137A has been sent to other college or university.
b. Notarized certification of non-enrollment for senior high school graduates who have not enrolled
in any technical/diploma/degree program immediately after graduation with "waiver" that if
there is concealment of previous enrollment, PUP enrollment becomes null and void.
3. I vouch the authenticity and genuineness of the documents I submitted to PUP;
4. I undertake and assume full and complete responsibility for all the consequences which
may arise in case the any of the documents I submitted is found to have been falsified or
fabricated;
5. I vouch that I have not enrolled in any Higher Education Institution other than PUP or
else my enrollment will be cancelled.
6. I understand that my admission is merely provisional and that the University reserves its
right to deny my application for enrollment or revoke my enrollment should the
information I declared or documents submitted have been found to be deceitful, fabricated
and falsified without prejudice to filing a criminal case against me; and
7. I am executing this Certification Under Oath in order for the University to proceed with
my enrollment.

IN WITNESS WHEREOF, I have hereunto set my hand this day ________of________, 20___ at
Sta. Mesa, Manila.

______________________________
AFFIANT

SUBSCRIBED AND SWORN to before me this__________ day of_________, 20___ in the City of
Manila, Philippines, affiant exhibiting to me his/her_________________________ as proof of his/her
identity.

____________________________________
PUP Legal Officer
 01223436789

9109 396
"&&'$
8 ''&$
03  8
 86#
 86#
 86#
 ($%
 4 ! 4 ! 4 ! 4 !

&


$ 00
  4"6 8$% 
 3&%
$ )*+, -.1''$$ / )*+,
123 456789:;<:=<>6?8@68<?@< GH< GH< GH< I:<J;5K8< GH< A4N<< <I:< O3 P8;C?=?8K<QBR9?6<A66:B@C5@C< W8C8@C?:@<W8LB?;8M8@C< <Z8T<
A66:B@C5@6D<E4>AF< ;8LB?;8M8@C< O3 S?@5@6?59<A@59DTC<
O3 AKU?T:;D<>8;U?68T<<
O3 >8@?:;<P:@TB9C?@J<N5@5J8;<
O3 >C5C8<A66:B@C5@C<?@<
V:U8;@M8@C<
O3 W8U?8X8;<=:;<PQAYT<
S56B9CD<
[23 456789:;<:=<>6?8@68<?@< GH< GH< GH< I:<J;5K8< GH< A4N< I:< O3 Q;:=8TT?:@59<M5@5J8;< W8C8@C?:@<W8LB?;8M8@C< I:<
N5@5J8M8@C<A66:B@C?@J< ;8LB?;8M8@C< O3 P:@C;:998;<
E4>NAF< O3 \:]<M5@5J8M8@C<]:T?C?:@<
O3 >C;5C8J?TC<?@<K86?T?:@<N5^?@J<
O3 S?@5@68<_?;86C:;<
O3 S56B9CD<
<
`23 456789:;<:=<>6?8@68<?@< Gb< G`< G`< G`< G`< A4N< Zc>< O345@^<P5T7?8;< IfA< I:<
4BT?@8TT<AKM?@?TC;5C?:@< O345@^<\8998;<
N5a:;<?@<S?@5@6?59< O3P;8K?C<A@59DTC<
N5@5J8M8@C<E4>4ASNF< O3P;8K?C<5@K<P:9986C?:@<ATT?TC5@C<
< O3S?@5@6?59<A@59DTC<<
O3S?@5@6?59<Q95@@8;<
O3S:;8?J@<cd675@J8<\;5K8;<
O3e@U8TCM8@C<A@59DTC<
O3>C:6^<\;5K8;<
\;85TB;D<ATT?TC5@C<
b23 4><A;67?C86CB;8<E4>gAWPheF< ij< GH< GH< GH< GH< Q;8=8;5R9D< Z8T< m3 nB@?:;<A;67?C86CB;59< <A]]9?65@C<C:<TBRM?C<C78< Z8T<

38< _;5=CTM5@f_8T?J@8;< =:99:X?@J<?@<8986C;:@?6<6:]D<o<
7:X8U8;k< m3 A;67?C86CB;59<W8@K8;8;< ]K=<=:;M5C<C:<
5]]9?65@CT< m3 4B?9K?@J<P:@TC;B6C?:@<A?K8< .%p'''%q
X7:<X?99<]5TT< m3 A;67?C86CB;59<N:K89<N5^8;< A]]9?65@C<C:<TBRM?C<?@<5<>7:;C<
C78<5]C?CBK8< m3 A;67?C86CB;59<>]568<_8T?J@8;< 4:@K<Q5]8;<T?r8<E5@D<]5]8;k<
C8TC<X?99< m3 W8T85;67f_:6BM8@C5C?:@< 8d2<s899BMk<:T9:F<
B@K8;J:< ATT?TC5@C< 52S;8875@K<?99BTC;5C?:@<:=<C78<
R;?KJ?@J< m3 P:@TC;B6C?:@<Q;:a86C<N5@5J8;< S5t5K8<:=<C78<8&$
];:J;5M<S?;TC< ATT?TC5@C< 1((0&?@<EQ8@<5@K<
>8M8TC8;<:=< m3 4B?9K?@J<P:@TC;B6C?:@< e@^<:@9DF<\78<K;5X?@J<MBTC<
AZ<[l[lg >B]8;U?T:;< ?@69BK8<]8:]98k<65;T<5@K<
[l[1< m3 Q;:a86C<cTC?M5C:;fATT8TT:;< C;88T2<&&
m3 PA__<>]86?59?TC< ('%$<
 8!!4"
789
 4""!849
00  789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89 93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./ 0123454367489:;<472<: A771JKKLLLM1A4@A4>78<C4938@8<M
./ =>>4>7697:?26@7A:69B:06527C: 38HK18<758@48KH694@6N18>7N
DE4@B49F:G9>12378<:
./ DE4@B49F:=BH494>7<67489:
=>>4>7697:IE7:987:@4H472B:78:

855432K:
:
OPQRSTUVWSXYZ[\PUVZYTVTZ[UV
[QVTPZ]SYXV
V
IM:^<22A69B:B<6L49F:85:
I6>_27:5E@@:85:5<E47:̀6<42742>:49:
a8@8<2B:1<2>29767489M:b8E:
H6C:E>2:38@8<2B:12934@c:
L672<38@8<c:3<6C:16>:8<:
38@8<2B:129>M:d^8<:38@8<c:
>A6B2>:69B:>A6B8L>e:f@26>2:

493@EB2:>8E<32:85:1A878:2MFM:
A771>JKK183_27H6F>M38HK7A2N
6<74>7NH6F6g492Kh69E6<CN
ijK6<743@2>KklmjjnK16497N
C8E<N54<>7N<26@4>7N>74@@N@452N49N
63<C@43>o5I3@4BpGL=qrHsnt=g
u77Av<f>1DLw<wtxlym3t@w0C
33rF4qfikzi{uG9N@H^;xbE|_:
OPQRSTUVWSXYZ[\PUVZYTVTZ[UV
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./012345670
89:;<=<>?:@ABC:DED?C:FGACH:
IAJ>:GAC<KAJHEL:LE@ABH:HA:
MABC:EC?EF:EJ>:<LLBFHCEH?:HG?:
MALLAN<JO:<J:P?J:EJ>:QJR:EJ>:
SALAC9:TAB:UE@:BF?:8ALAC?>:
D?J8<LV:NEH?C8ALACV:8CE@:DEF:AC:
8ALAC?>:D?JF9W:X2/Y51Z0
[5763.\2Z0361013.Z0./0
12345670
]2340^_`0/60\aaZ20bZc.032Z3d0
^_e0/60.fZ0\aaZ20257f.032Z3d0
^_g0/60.fZ0b/4Z20bZc.032Z30
3610h_i0/60.fZ0b/4Z20257f.0
32Z3_0
89j9:k:l:k:mBI<RnF:SBI?:oCAJH:
=<?N:$2!212!*319(
89p9:k:l:k:mBI<RnF:SBI?:qAD:
=<?N: :
89k9:k:l:k:mBI<RnF:SBI?:r?MH:
s<>?:=<?N: :
89t9:k:l:k:mBI<RnF:SBI?:
QFAU?HC<8:=<?N::FGAN<JO::
oCAJH:EJ>:m<OGH:s<>?::
X2/Y51Z0[5763.\2Z0361013.Z0
./012345670
>9uFFE@W:vU<J<UBU:AM:wx:
NAC>FV:UEl<UBU:AM:jxx:
NAC>Fy:
>9j9:zG@:>A:@AB:NEJH:HA:HER?:
BD:{C8G<H?8HBC?|::
>9p9:zGEH:}BEL<H<?F:>A:@AB:
GE=?:HA:NABL>:}BEL<M@:@AB:HA:
I?:E>U<HH?>:<J:HG<F:DCAOCEU|:
>9~J?:U<JBH?:=<>?A:HA:
<JHCA>B8?:@ABCF?LM:EJ>:NG@:
@AB:>?F?C=?:HA:I?:EJ:€,2!41
"4144-4‚49ƒ
?9:qG?:DACHMAL<A:FGABL>:
<J8LB>?:E:>BL@:F<OJ?>:
8?CH<M<8EH<AJ:AM:EBHGACFG<D:
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./01.213456.24.21478896:7.6/;4
</3=>4$4 59(
4
?>@ AB4C;.136/34D1E60;4FABCDG44 HI4 J?4 J?4 J?4 J?4 K994E.37;LE4 M1E4 NO@ PQ;6/34C;.136/34D1E60;134 K8896:7;.4./4EQe=6.4.214 M1E44
RO@ KEE6E.7;.4S/==13:6794B87:14 </99/56;046;4191:.3/;6:4:/8\4f4
T97;;134 8L<4</3=7.4./4
UO@ T3/<1EE6/;794V1;L13134 *8g""

" h
WO@ X/L194X7Y134 i@K8896:7;.4./4EQe=6.46;474
ZO@ KEE6E.7;.4V1.76947;L4 B2/3.4A/;L4T78134E6j14F7;\4
C;E.6.Q.6/;794B87:14T97;;134 87813k41l>4m199Q=k4/E9/G4
[O@ D6E897\4K3.6E.4 7>K4<31127;L4L3756;04/<4e97:Y4
]O@ B2/53//=4B.\96E.4 7;L4526.14E.699496<14Fn7E147;L4
^O@ _Q3;6.Q314D1E60;4KEE6E.7;.4 <9/513G4L3756;04QE6;047;\4
`O@ _9/3794K337;0134 =1L6Q=4F1>0>481;:69k4e799481;k4
NaO@V1E6L1;.679bV1.7694_Q3;6.Q314 1.:>G>4
D1E60;134 opqrstuhvswxyz{puhyxthtyzuh
NNO@D1873.=1;.4B./314D1E60;134 zqhtpy|sxw}
NRO@V1.7694B81:6796E.4B./314 e>K4:/9/31L46;.136/34
D1E60;134 813E81:.6n14L3756;04/<474
NUO@c<<6:14_Q3;6E26;04D1E60;134 96n6;047317431;L131L4QE6;04
NWO@T3/LQ:.47;L4X7;Q<7:.Q36;04 7;\4/<4.214</99/56;04:/9/36;04
D1E60;134 =7.13679Ek457.13:/9/3k4:/9/31L4
NZO@T3/LQ:.4X7;701=1;.4 81;:69k4=73Y13Ek41.:>456.2474
KEE6E.7;.4 e361<4L6E:QEE6/;4/<4.214:/9/34
N[O@SKDD4B81:6796E.4
N]O@B81:6<6:7.6/;4d36.134
N^O@V1E173:24KEE6E.7;.4
4
N`O@XQE1Q=4d/3Y4B.7<<4
RaO@C;.136/34D1E60;4_17.Q314 zqhtpy|sxw}
d36.134
E:21=1>425"1
391414~893892
4!!2~
opqrstuhvswxyz{puhyxthtyzuh
:>K;46;.136/34191n7.6/;4
E2/56;0474L//3k456;L/5k4
.7e9147;L4:2763>4F4 59
-(4
opqrstuhvswxyz{puhyxthtyzuh
zqhtpy|sxw}
L>K;4/3.2/037826:4L3756;04/<4
7456;04:2763>4
opqrstuhvswxyz{puhyxthtyzuh
zqhtpy|sxw}
1>EE7\€4F=6;6=Q=4/<4?4
5/3LEk4=7l6=Q=4/<4‚4
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./01234
5676489:41/4:/;4.<=>4>/4><?54
;@4A=>50B/04C52BD=E4
56F489<>4G;<HB>B5241/4:/;4
9<I54>/4./;H14G;<HBJ:4:/;4>/4
K54<1LB>>514B=4>9B24@0/D0<LE4
J64M=5N4LB=;>54IB15/4>/4
B=>0/1;O54:/;025HJ4<=14.9:4
:/;415250I54>/4K54<=4PQ,2!41
"4144-4R49S

D64T954@/0>J/HB/429/;H14
B=OH;154<41;H:42BD=514
O50>BJBO<>B/=4/J4<;>9/029B@4
>/D5>9504.B>94>954<@@HBO<>B/=4
J/0L64$4 59(
'+QUQ'0+VQ%
W6X Y<O95H/04/J4Z0>24B=4[=DHB294 _F4 _F4 `aZ4 `aZ4 _b4 ]T[c4 i524 jX f=BI502B>a]5=BB/04eBD94]O9//H4 `/4]9BJ>B=D4o/HBO:4 `/4
\<=D;<D54]>;1B524^ZY[\]34 ZYc4 4 [=DHB294A=2>0;O>/04
dZ]4 jX Y//?480B>50aZ;>9/04
efc]]4 jX T5O9=BO<H480B>504
ZCT4 jX [1B>/0B<H4Z22B2><=>4
T[gehMg4 jX [=DHB294<24<4k/05BD=4\<=D;<D54
T5<O9504
jX T0<=2H<>/04
jX \5lBO/D0<@9504
jX c51B<4m525<0O9504
jX m525<0O9504
jX n/;0=<HB2>4
jX o;KHB29B=D4g/@:N
[1B>/0ao0//J05<1504
jX CBDB><H4g/@:.0B>504
jX C/O;L5=><0B<=4
jX 85K4g/=>5=>4a]/OB<H4c51B<4
c<=<D504
jX o<0<H5D<H44
p6X Y<O95H/04/J4Z0>24B=4 _F4 _F4 `aZ4 `aZ4 _b4 ]T[c4 i52q4 jX f=BI502B>a]5=BB/04eBD94]O9//H4 `/4]9BJ>B=D4o/HBO:4 `/4
\B>50<>;054<=14g;H>;0<H4 ZYc4 rstuvwxyz{y [=DHB294A=2>0;O>/04
]>;1B524^ZY\g]34 dZ]4 t||v}vzwt~€v jX kBO>B/=a`/=NJBO>B/=4
efc]]4 |xvwxy 80B>50aZ;>9/04
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./01 789:;<=7>?@A;> XY Z[\]^_`\]_a\1
02345631 BC;D=@E;> XY bca_1
FGHIJ@<=@GH> XY .\_14]d_c\]ef1
DHK>BC;D=@E;> XY 3gh_g\eh1.f_\ic^ch]j]d_1
LC@=@HM>N@??> XY kgdagl13g\e_c\1
K;O;HK>GH> XY .\_d1efm13gh_g\a13cc\m]fe_c\1
=P;>C;E@;N>GQ> XY 2m]_c\]eh1.dd]d_ef_1
;R8@ED?;H=> XY nao][cj\e^ia\1
8H@=7S<G8C7;7> XY padae\[ia\1
=DA;H>9T> XY qcg\feh]d_1
7=8K;H=7>@H> XY bgrh]di]fj13c^st
=P;>UVUW>1 2m]_c\ub\ccv\aema\1
XY /c[glaf_e\]ef1
XY war13cf_af_1uZc[]eh1kam]e1
kefeja\1
XY 2fjh]di1ed1e1xc\a]jf1nefjgeja1
0ae[ia\1
XY be\ehajeh1
XY 0\efdhe_c\1
yzY {e_d]hsa\1fj1.\_ad1de1 y~1 y~1 u.1 u.1 u.1 Z02k1 ‚ad1 XY Zaf]c\4]ji10ae[ia\1 c1Zi]v_]fj1bch][s1 c1
x]h]^]fchci]se1|.{x}1 .{k1 XY f]ƒa\d]_s„fd_\g[_c\1
€.Z1 XY padae\[ia\1
4kZZ1 XY 0\efdhe_c\1
./01 XY Z[\]^_w\]_a\1
02345631 XY .\_]d_1
XY 3gh_g\eh̀c\…a\1
XY /]\a[_c\1
XY {cc…1̀\]_a\1
XY n]_a\e\s1̀\]_a\1
XY /c[glaf_e\]ef1
XY 2mg[e_]cfehkefeja\1
XY /a^e\_laf_3cc\m]fe_c\1
†zY {e[iahc\1cv1.\_d1]f1 y~1 y~1 u.1 u.1 u.1 Z02k1 ‚ad1 XY Zaf]c\4]ji10ae[ia\1 c1Zi]v_]fj1bch][s1 c1
bi]hcdc^is1|.{tb4„n6}1 .{k1 XY f]ƒa\d]_s„fd_\g[_c\1
€.Z1 XY padae\[ia\1
4kZZ1 XY 4p1kefeja\1
./01 XY Z[\]^_w\]_a\1
02345631 XY .\_]d_1
1 XY 3gh_g\eh̀c\…a\1
1 XY b\atne`1
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
. /0 1223.456785.
. /0 96785:5;.456785.
. /0 <2=>?8@7:56:@.
. /0 AB>=:725.
. /0 A@758C58@8>5.
DEF01:=G8H25.2I.J85I25?6@K.L57M. RS. RS. TUL. TUL. TUL. VOAW. ^8M. /0 AB>=:725.PV8@625.Y6KG. . T2.
?:N25.6@.OG8:785.L57M. L1W.. V=G22H.O8:=G85_.Z@6̀85M67;.
P1JALQ.PI25?85H;.1L.OG8:785. XLV.. a@M75>=725Q.
L57MQ.. YZWVV. /0 JH:;456KG7..
.L<O. /0 V7:K8.<658=725.
.OA[Y\][. /0 [58:76̀8UL576M76=.<658=725..
/0 O8=G@6=:H.<658=725.
/0 L=725.I25.V7:K8_.O\.:@B.
b6H?.V7:K8.W:@:K85.
/0 <8M6K@85.PV87_.[2M7>?8_.
96KG7M_.V2>@BMQ..
/0 96̀8.J85I25?85.
/0 J52B>=762@.W:@:K85.
/0 Y2>M8.W:@:K85.
/0 J52B>=762@.[225B6@:725..
/0 [>H7>5:H.c25385.
DDF01:=G8H25.2I.V=68@=8.6@. Rd. RE. RE. RE. RE. L1W.:@B. ^AV_.e>7.46HH. b52?.2II6=8.M7:II.72.2II6=8.?:@:K85. . T].
]II6=8.LB?6@6M75:762@. XLV. 7:38.e56BK8.
P1V]LQ. =2>5M8M.
DSF01:=G8H25.2I.V=68@=8.6@. Rd. RE. RE. RE. RE. L1W.:@B. ^AV_.e>7.46HH. a@75:C58@8>5.:@B.A@758C58@8>5. . T].
A@758C58@8>5MG6C. . XLV. 7:38.e56BK8.
P1VATOfAJQ. =2>5M8M.
DdF01:=G8H25.2I.V=68@=8.6@. Rd. RE. RE. RE. RE. L1W.:@B. ^AV_.e>7.46HH. b52?.2II6=8.M7:II.72.2II6=8.?:@:K85. . T].
1>M6@8MM.LB?6@6M75:762@. . XLV. 7:38.e56BK8.
?:N25.6@.Y>?:@.f8M2>5=8. =2>5M8M.
W:@:K8?8@7.P1V1LYfWQ.
DgF01:=G8H25.2I.V=68@=8.6@. Rd. RE. RE. RE. RE. L1W.:@B. ^AV_.e>7.46HH. b52?.2II6=8.M7:II_.H6@8hC85M2@@8H_. . T].
1>M6@8MM.LB?6@6M75:762@. . XLV. 7:38.e56BK8. M:H8M.72.A@758C58@8>5.
?:N25.6@.W:53876@K. . =2>5M8M.
W:@:K8?8@7.P1V1LhWWQ.
DiF01:=G8H25.2I.L57M.6@. Rd. Rd. Rd. Rd. Rj. YZWWV. ^8M. 152:B=:M785. T2.VG6I76@K. T2.
152:B=:M76@K.P1L1fQ. L=725.
b6H??:385.
V=56C7456785.
T84M.L@=G25.
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./012/0/34
56789:;87194<2976=12>4
<2976=?8934@?/AA4
@9=8/B4C178/4C/3/D124
EF13?>4C/3/D124
GHIJK/=L1B9249A452?4834 PQ4 PQ4 PQ4 PQ4 PQ4 RSCC@4 T1>4 U28?12VE78?924 _94@L8A?83D4 _94
M9623/B8>04NK5MO4 4 W1X92?124
4 C178/4EY1=6?8F14
4 .93?13?4U28?124
<2976=?89345>>8>?/3?4
@1D013?4<2976=124
Z3A920/?8934[AA8=124
<L9?9\9623/B8>?4
<L9?9D2/XL124
<299A21/7124
E78?928/B4./2?9938>?4
]2/XL8=452?8>?4
E78?928/B4@?/AA4
C178/4W1>1/2=L124
.9004W1B/?174\9^>4
G`IJK/=L1B9249A452?>4834 Pa4 PQ4 PQ4 PQ4 PQ4 RSCC@4 T1>4 W1>1/2=L124924E76=/?924 _V54 _94
.900638=/?8934W1>1/2=L4 53/Bb>?4
NK5.WO4 .900638=/?8934@X1=8/B8>?4
K29/7=/>?4M9623/B8>?4924
.900638=/?924
U28?124924E78?924
c/db124
.92X92/?14.900638=/?8934EF13?>4
C/3/D124
./0X/8D34.93>6B?/3?4924<B/33124
e8D8?/B4C/2f1?124
K99f456?L924
@9=8/B4C178/4C/3/D124
GPIJK/=L1B92483457F12?8>83D4/374 Pa4 PQ4 PQ4 Pa4 PQ4 5KCgRSCC T1>4 <6^B8=4W1B/?893>4[AA8=12g4<6^B8=4 _94>L8A?83Dg4=/21124=L98=14 394
<6^B8=4W1B/?893>4NK5<WO4 @g45Wh4i4 Z3A920/?8934[AA8=12g457F12>?8>83D4 06>?4^14637124
eE@Z]_4 ./0X/8D34=93>6B?/3?g4C/2f1?4 /7F12?8>83DVX6^B8=4
W1>1/2=L4EY1=6?8F1g4C/2f1?83D4 21B/?893V71>8D3V=21/?8F1>V^2/
5==963?4C/3/D12g4C/2f1?83D4 3783DI4UL8=L401/3>4L1V>L14
5>>8>?/3?g4EF13?>4C/3/D12g4 /B21/7b4f39d>4L8>VL124=/21124
.92X92/?14.900638=/?893>4 X/?LI4
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
0123145
93!8 149 $%&'2(
@ABCD/EF2>;35;G5HEI20E25I05
J0G;3K/?I;05L2EF0;>;1M5
NDHJLO5
cdBCD/EF2>;35;G5HEI20E25I05
:;KZ=?235HEI20E25NDH:HO5
c@BCD/EF2>;35;G5HEI20E25I05:I_I>5
T01I0223I015NDH:TO5
21 14 14 14 14 4!839 149 -24121
81  8974 8989 89
)2*+""21988 541, $%&'2(
./0/1234567895:;0<=>?/0?45
AP5 QRS5 QPS5 QPS5 QPS5 HLT.5 5 L2EF0IE/>5H=ZZ;3?5HZ2EI/>I<?5 D3I^125:;=3<25?;5a25 Y;5
LT:UVW;E55 Y;5 :;KZ=?235[Z23/?;35 ^2?23KI02^5
J:L5 Y2?\;3]5T01I02235
X6H5 Y2?\;3]56^KI0I<?3/?;35
:;KZ=?23583;13/KK235
H;G?\/325T01I02235
HM<?2K<560/>M<?5
HM<?2K<572_2>;Z235
`2a572<I10235
7/?/a/<256^KI0I<?3/?;35
92<2/3EF235
JL583;b2E?5./0/1235
JL5J0<?3=E?;35
JL5T0?32Z3202=35
J0G;3K/?I;05H2E=3I?M56^KI0I<?3/?;35
AP5 AdS5 QPS5 QPS5 QPS5 HLT.5 Y;5 92<2/3EF56<<I<?/0?5 D3I^125:;=3<25?;5a25 Y;5
LT:UVW;E5 :;KZ=?235[Z23/?;35 ^2?23KI02^5
J:L5 L2EF0IE/>5̀ 3I?235
X6H5 7/?/a/<2583;13/KK23e72<I10235
:;KZ=?23583;13/KK25
H;G?\/325T01I02235
HM<?2K<560/>M<?5
HM<?2K<572_2>;Z235
6ZZ>IE/?I;0<572_2>;Z235
f=/>I?M56<<=3/0E25T01I02235
J0G;3K/?I;05H2E=3I?M5T01I02235
92<2/3EF235
Y2?\;3]5HZ2EI/>I<?5
HM<?2K<56^KI0I<?3/?;35
:;KZ=?235HEI20E25J0<?3=E?;35
5
AR5 AdS5 QgS5 QgS5 QgS5 5HLT.5 5hTH5 5 5Y;025 5hTH5
iC :I_I>5T01I0223
iC H?3=E?=3/>5T01I02235
iC X2;?2EF0IE/>5T01I022355
iC T0_I3;0K20?/>5T01I02235
iC 83;b2E?5./0/1235
iC 83;b2E?5T01I02235
iC `/?23532<;=3E25T01I02235
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./ 0123456789:73
./ ;1<3;03=>?56@9:73
./ 0123456789:73
./ A>BC>667C>B3DE7F6G:73
./ ;E8>9C9G3DE7F6G:7?3
./ ;1<3;03=>?56@9:73
./ HI8>>C>B3A>BC>6673
./ ;E8IC9G30:>97:I3A>BC>6673
3
JJK/LD30:M5E9673A>BC>667C>B3 PQ3 RRS3 RTS3 RTS3 RUS3 DVAW3 XAD3 ./ 0:M5E9673A>BC>6673 Y:>63 Y43
NLD04AO3 ./ 0:M5E967326?CB>673
3 ./ DG?96M3A>BC>6673
3 ./ Y69Z:7[3A>BC>6673
./ =0V3=>\78?97E@9E763A]56793
./ 289831>8IG?93
./ DG?96M3A]5679<1>8IG?93
./ 1E9:M89C:>3A>BC>6673
./ ^:_:9C@?<W6@`8>97:>C@?3
./ H7:a6@93W8>8B673
JbK/L8@`6I:73:\3D@C6>@63C>3 PT3 PQS3 RUS3 RUS3 RcS3 3DVAW3 3X6?3 ./ 4CI38>d3e8?3A>BC>6673 Y:>63 X6?3
AI6@97C@8I3A>BC>667C>B3NLDAAO3 ./ H:Z673A>BC>6673
./ 0:>?97E@9C:>3A>BC>6673
./ AI6@97C@8I3A>BC>6673
./ AI6@97C@8I326?CB>3A>BC>6673
./ DE_?989C:>3A>BC>6673
./ H7:a6@93W8>8B673
./ 1E9:M89C:>3A>BC>6673
./ ^8CIZ8G3A>BC>6673
3
JfK/L8@`6I:73:\3D@C6>@63C>3 PT3 PQ3 PQ3 RR3 RR3 DVAW3 X6?3 D56@C\C@3H7:\6??C:>?3:73:@@E589C:>?3 1@@6596d3?9Ed6>93C?3?E_a6@93 X6?3
AI6@97:>C@?3A>BC>667C>B3NLDg 9`8939`63LDgA0A3B78dE8963M8G3B:3 9:3iE8IC\GC>B38>d37696>9C:>3
A0AO3 C>9:3ZC9`h3 8\96739`63jC7?93X6873k6F6I3
./ L7:8d@8?9C>B3
./ V6I6@:MME>C@89C:>?3
./ WC@7:6I6@97:>C@?3
./ ^:_:9C@?38>d3W6@`897:>C@?3
./ H:Z673AI6@97:>C@?3
./ LC:96@`<LC:M6dC@8I3
AI6@97:>C@?3
./ =>\:7M89C:>38>d3
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./001234563/2789:4;2/</=>8
?2@A576A1461A:8B?.9C8
D36;86;:8@/<</D32=8D/AE8636<:F8
GHI J<:46A/234789:4;2343528
KHI J<:46A/23478J2=32::A78
LHI MA/@:773/25<8J<:46A/23478
J2=32::A78
KNHIO54;:</A8/@8P43:24:8328 RS8 TTU8 TVU8 TVU8 TNU8 8P9JW8 X:78 ?2Q176A35<8J2=32::A8 8_/2:8 _/8
?2Q176A35<8J2=32::A32=8BOP?JC8 MA/4:778J2=32::A8
YZ:A563/278[:7:5A4;8PZ:435<3768
\15<36>8./26A/<8J2=32::A8
MA/]:468J2=32::A8
W521@5461A32=8J2=32::A8
P5@:6>8J2=32::A8
P1ZZ<>8.;5328W525=:0:268
J2=32::A8
O1732:778^25<>768
KVHIO54;:</A8/@8P43:24:8328 R`8 RSU8 TVU8 TVU8 TNU8 8P9JW8 _Y8 M/D:A8M<5268J2=32::AaYZ:A56/A88 8_/2:8 X:78
W:4;52345<8J2=32::A32=8 M/D:A8M<5268b:73=28J2=32::A88
BOPWJC8 WJ8?276A146/AaMA/@88
cd^.8J2=32::A88
cd^.8./26A546/A88
?2Q176A35<8M<526b:73=28J2=32::A88
P5@:6>8J2=32::A8
\15<36>8./26A/<8J2=32::A88
b:73=28J2=32::A88
.5A8M<5268J2=32::A8
K`HIO54;:</A8/@8P43:24:8328 RS8 TTU8 TVU8 TVU8 TVU8 8P9JW8 8XJP8 eI .3f3<8J2=32::A32=8 8_/2:8 8_Y8
[53<D5>8J2=32::A32=8BOP[JC8 9:4;2/</=3767a89:4;23435278
eI .^b8YZ:A56/A8
eI \^a8\.8?27Z:46/A8
eI .^b8YZ:A56/A8
eI J2=32::A32=8P1Af:>/A8
eI [53<8W5326:2524:8
9:4;2343528
eI \152636>8P1Af:>/A78
eI \^a8\.8?27Z:46/A8
eI M<52232=8J2=32::A8
eI \15<36>8./26A/<8J2=32::A8
eI 9A5328bA3f:A8
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./ 0123415671869:;<=2;21=6
./ 01234156>1?:@56A=B2=::86
./ 01234156A=B2=::86
6
CDE/F1;<:3G86G?6FHI2=:II6 S1II2=B601@:6 DCT6 DUT6 DUT6 DUT6 V=56>@81=J6 W:I6 X156@:1;<6?G33G42=B6IHYN:;@IZ6 gG6><2?@2=B6 W:I6
9:;<=G3GB561=J6K2L:32<GGJ6 ./ [:=:8136\??2;:6S8G;:JH8:I6
AJH;1@2G=6M1NG862=6 1=J6FHI2=:II6A@<2;I6
O=?G8M1@2G=61=J6 ./ F1I2;67GM]H@:86
7GMMH=2;1@2G=69:;<=G3GB56 V]]32;1@2G=I6
PFF9KAQO79R6 ./ A=@8:]8:=:H8I<2]6
./ FGG^^::]2=B6
./ 0:@1236X:8;<1=J2I2=B6
./ FHI2=:II6\8B1=2_1@2G=61=J6
X1=1B:M:=@6
./ 9:;<=G3GB561=J6K2L:32<GGJ6
AJH;1@2G=6P`GM:6
A;G=GM2;Ia6O=JHI@82136V8@Ia6
O=?G8M1@2G=61=J6
7GMMH=2;1@2G=6
9:;<=G3GB561=J6VB82b
c2I<:856V8@IR6G?6@<:6dH=2G86
`2B<6>;<GG36
./ VFX6981;^6G?6@<:6>:=2G86
`2B<6>;<GG36
X1564G8^61IZ6
./ c8G=@6Q:I^6>]:;2132I@6
./ 7HI@GM:86>:8L2;:6
0:]8:I:=@1@2L:6
./ 73:82;136>]:;2132I@6
./ >13:I67GH=I:3G86
./ Q1@16A=@856\]:81@G86
./ FGG^^::]:86
./ F1=^69:33:86
./ 7G33:;@6G=6VB:=@6
./ \??2;:6>H]]G8@6>@1??6
./ 7GM]H@:86>:;8:@1856
./ Ae:;H@2L:6VII2I@1=@6
./ K:B1367GH8@6>@:=GB81]<:86
./ 713367:=@:86VB:=@6
./ 9812=:8f9H@G86
./ O=L:=@G8561=J6
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./012345676489:/07;44/<9
=> ?4@0/A0/4/B0C9
DB764/77E349
=> F47@0B1@6;43<9.3@/063<9
GA/163<67@9
9
HIJ>D312/<;09;K9DB764/779 :3776489U3@/9 VHW9 VXW9 VXW9 VXW9 Y4M9G@03459 Z/79 .3M9@/3129K;<<;[64897B\P/1@7]9 h;9G26K@6489 Z/79
L/124;<;8M93459N6O/<62;;59 => ^/4/03<9_KK61/9:0;1/5B0/79
?5B13@6;49E3P;09649Q;E/9 3459DB764/779?@26179
?1;4;E6179RDDLN?SQ?T9 => D37619̀;EAB@/09
YAA<613@6;479
=> ?4@0/A0/4/B0726A9
=> D;;aa//A6489
=> U/@36<9./012345676489
=> DB764/779_08346b3@6;493459
.3438/E/4@9
=> L/124;<;8M93459N6O/<62;;59
?5B13@6;49RQ;E/9
?1;4;E617c9F45B7@063<9Y0@7c9
F4K;0E3@6;493459
`;EEB4613@6;49
L/124;<;8M93459Y806d
e672/0M9Y0@7T9;K9@2/9fB46;09
Q6829G12;;<9
=> YD.9L031a9;K9@2/9G/46;09
Q6829G12;;<9
.3M9[;0a937]9
=> e0;4@9S/7a9GA/163<67@9
=> `B7@;E/09G/0O61/9
U/A0/7/4@3@6O/9
=> `</0613<9GA/163<67@9
=> G3</79̀;B47/<;09
=> S3@39?4@0M9_A/03@;09
=> D;;aa//A/09
=> D34a9L/<</09
=> `;<</1@9;49Y8/4@9
=> _KK61/9GBAA;0@9G@3KK9
=> `;EAB@/09G/10/@30M9
=> ?g/1B@6O/9Y7767@34@9
=> N/83<9̀;B0@9G@/4;803A2/09
=> `3<<9̀/4@/09Y8/4@9
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./ 0123451607891:
./ ;4<54891=:24>:
?51@A24>3B34C:D51B9445E:
./ F4815G1545716:
H7B345BBI24:
./ ;4B817@83942E:?285132E:
JG5@32E3B8:
:
KLM/H2@A5E91:9N:H7B345BB: D2BB34C:U285: VWX: VYX: VYX: VYX: Q4=:J8124>: Z5B: ?2=:852@A:N9EE9[34C:B7\P5@8B]: i9:JA3N834C: Z5B:
05@A49E9C=:24>:O3<5E3A99>: ./ ^54512E:_NN3@5:D19@5>715B:
F>7@28394:I2P91:34: 24>:H7B345BB:F8A3@B:
;4>7B8132E:Q18B:RHH0OFS;QT: ./ H2B3@:̀9IG7851:
QGGE3@28394B:
./ F4815G154571BA3G:
./ H99aa55G34C:
./ U5823E:?51@A24>3B34C:
./ H7B345BB:_1C243b28394:24>:
?242C5I548:
./ 05@A49E9C=:24>:O3<5E3A99>:
F>7@28394:Rc9I5:
F@949I3@Bd:;4>7B8132E:Q18Bd:
;4N91I28394:24>:
`9II743@28394:
05@A49E9C=:24>:QC13e
f3BA51=:Q18BT:9N:8A5:g74391:
c3CA:J@A99E:
./ QH?:012@a:9N:8A5:J54391:
c3CA:J@A99E:
?2=:[91a:2B]:
./ f1948:S5Ba:JG5@32E3B8:
./ `7B89I51:J51<3@5:
U5G15B548283<5:
./ `E513@2E:JG5@32E3B8:
./ J2E5B:̀974B5E91:
./ S282:F481=:_G512891:
./ H99aa55G51:
./ H24a:05EE51:
./ `9EE5@8:94:QC548:
./ _NN3@5:J7GG918:J82NN:
./ `9IG7851:J5@15821=:
./ Fh5@783<5:QBB3B8248:
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
0123145
93!8 149 $%&'2(
NOP/L3H>147957Q5@1H><AH34R J3IIA<25Y3:15
S7H3:A7<345@13H>195
KF8H3:A7<5M3T795A<5U77F5
;19DAH15G3<321M1<:5
VL@S@KWU;GX5
N[P/L3H>147957Q5K41M1<:39E5 J3IIA<25Y3:15
KF8H3:A7<55
VLKKWX5
NNP/L3H>147957Q5;1H7<F39E5 J3IIA<25Y3:15
KF8H3:A7<5G3T795A<5K<24AI>55
VL;KWKdX5
21 14 14 14 14 4!839 149 -24121
81  8974 8989 89
)2*+""21988 541, $%&'2(
./ 0123456789:5;:1<7293=>195
./ 6344561<:195?21<:5
./ @93A<19B@8:795
./ C<D1<:79E53<F5
G19H>3<FAIA<25J19I7<<145
./ K<:91=91<189B5
L8IA<1IIM3<5
./ C<I:98H:A7<345G3:19A345
;=1HA34AI:5
Z[\5 ZO\5 ZO\5 ZO\5 ?<E5;:93<F5 ]1I5 @13H>195A<55 d75;>AQ:A<25 ]1I5
./ @0K5Q795^93F1I5_RO`a55
./ ;1<A795bA2>5;H>7745Q795:>15
@1H><AH34RS7H3:A7<345
0AD14A>77F5V@S0X5@93Hca55
./ @1H><AH34RS7H3:A7<345
KF8H3:A7<53<F5@93A<A<25
V@SK@Xa53<F55
./ bA2>195KF8H3:A7<5
A<I:A:8:A7<I57QQ19A<25
L@S@KF53<F57:>195344A1F5
H789I1I5
Z[\5 ZO\5 ZO\5 ZO\5 ?<E5;:93<F5 ]1I5 ./ ;H>7745:13H>195A<5=9AD3:15 d75;>AQ:A<25 ]1I5
795=8e4AH5I1H7<F39E5
IH>774I5
./ @8:79I5795;>3F7f5@13H>19I5
Z[\5 ZO\5 ZO\5 ZO\5 ?<E5;:93<F5 ]1I5 ./ ;H>7745:13H>195A<5=9AD3:15 d75;>AQ:A<25 ]1I5
795=8e4AH5I1H7<F39E5
IH>774I5
./ K;0BKU05:13H>195
./ g<4A<15:8:795Q795Q791A2<5795
47H345I:8F1<:I5
./ ;=11H>53<F5f9A:A<25
H73H>B:93A<195
./ KFA:79B=977Q5913F19BH7=E5
913F195
./ h9A:195Q795<1fI=3=19I53<F5
M323iA<1I5
./ 0A:1939E5f9A:195795=71:5
./ @93<I43:795
./ ;=11H>5f9A:1955
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./ 0112345364785
./ 94:;5:72<475
=>?/@A3B46C75C15D43CEFA7G5 QA;;2ER5SA<45 TUV5 TWV5 TWV5 TWV5 XEG5D<7AEF5 Y4;5 ./ D3BCC65<4A3B4752E5Z72[A<45 9C5DB21<2ER5 Y4;5
HFI3A<2CE5JAKC752E5 C75ZI\6235;43CEFA7G5
JA<B4LA<23;5M@HDHN5JOP5 ;3BCC6;5
./ OI<C7;5C75DBAFC:5O4A3B47;5
=]?/@A3B46C75C15D43CEFA7G5 QA;;2ER5SA<45 TUV5 TWV5 TWV5 TWV5 XEG5D<7AEF5 Y4;5 ./ ^2RB5D3BCC65<4A3B4755 9C5DB21<2ER5 Y4;5
HFI3A<2CE5JAKC752E5DC32A65 ./ S4;4A73B475
D<IF24;5M@HDHNDDP5 ./ @CC85:72<475
=_?/@A3B46C75C15D43CEFA7G5 QA;;2ER5SA<45 TUV5 TWV5 TWV5 TWV5 XEG5D<7AEF5 Y4;5 ./ bI7C5;A5JA<AA;5EA5 9C5DB21<2ER5 Y4;5
HFI3A<2CE5JAKC752E5̀262Z2EC5 QAA7A6AE5C5^A2;8I65
M@HDHN`aP5 ./ JAEIEI6A<cOA6ILZA<25
./ OARAZAR;AEAG5;A5
ZAR<A<A6ILZA<2d5ZAR;I6A<5
ER5LRA5;AEAG;AGd5A<52\A5
ZAER58A;AEAGAER5
ZAER:28A5
./ eA:AE25;A5LRA5Z72\AFC5A<5
ZI\628CER5<AERRAZAE5
./ XEA:E;475
./ JALALABAGAR5
./ eA<I:AER5;A5
eCLIE28A;GCER5
QAERLAF6A5
./ OARAZAR;A62ERc:28A5
./ JAEIEI6A<5
./ HF2<C75
./ eA<I:AER5ER5HF2<C75
=f?/@A3B46C75C15D43CEFA7G5 QA;;2ER5SA<45 TUV5 TWV5 TWV5 TWV5 XEG5D<7AEF5 Y4;5 ./ b7AFIA<4;5C15<B45@DHF5 9C5DB21<2ER5 Y4;5
HFI3A<2CE5JAKC752E5D324E345 D324E345Z7CR7AL5A7452E5
M@HDHNDgP5 F4LAEF52E5ZI\6235AEF5
Z72[A<45 64A7E2ER5
2E;<2<I<2CE;d5 6C3A65 AEF5
A\7CAFd52E5<B45;43CEFA7G5
AEF5;4E2C75B2RB5;3BCC65
64[46;?5gA74475CZZC7<IE2<24;5
:2665 ;I746G5 2E36IF45
A3AF4L235AEF5;3BC6A76G5
:C785 A;5 <4A3B47;d5
74;4A73B47;5AEF54[4E52E5
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
0123145
93!8 149
NO>@B.941/:E3:63C19:<2.EL3
D289.50:<3P.Q:E30<3D.E/L3
R40/24::23SBDRDTU3
N_>@B.941/:E30<3̀0=E.EL3.<23 V.770<F3W.513 OXY3
a<6:EG.50:<3C901<913SB`aCU3
de>@B.941/:E3:63V4L709./3
D289.50:<3SBVDTU3
3 ?@ R:.94g3AE.0<1E3
dZ>@B.941/:E3:63C901<9130<3
Dc1E90713.<23C;:E573C901<913
SBCDCCU3
3 ?@ C;:E573C901<50753
dX>@B.941/:E3:63[E5730<3V:/0509./3
C901<913SB[VCU3
21 14 14 14 14 4!839 149 -24121
81  8974 8989 89
$%&'2( )2*+""21988 541, $%&'2(
.//012341./543601/27378943.73
4:7;05./73.<23=870<17717>3
?@ A413BCD23C901<913;E:FE.G3
2E.H736E:G3I.E0:873.//0123
20790;/0<173 /0J13 7:90./3
7901<917K3 G.541G.5097K3
5194<:/:FLK3/.<F8.F173.<23
48G.<0501735:31<78E1354.53
5413 FE.28.5173 4.I13 .3
G8/50M20790;/0<.EL3
;E1;.E.50:<30<39:<51<53.<23
;12.F:FL>3
V.770<F3W.513 OXY3 OZY3 OZY3 OZY3 [<L3C5E.<23 \173 ?@ ]E.28.5173:63B.941/:E3 ^:3C40650<F3 \173
D.E/L3R40/24::23D289.50:<3
SBDRD2U3G.L3:=5.0<3.3
51.940<F3;:7050:<30<3;8=/093
:E3;E0I.513794::/7K3:E3.73
585:E73:E374.2:H351.941E7>3
OZY3 OZY3 OXY3 [<L375E.<23 \173 ?@ `0=E.E0.<3 ^:3740650<F3 \173
?@ [=75E.95:E3
?@ W171.E941E3
?@ A1.941EM`0=E.E0.<3
?@ T:98G1<5.50:<3b66091E3
?@ a<21c1E3
?@ W19:E273b66091E3
?@ a<6:EG.50:<3C;190./0753
?@ B0=/0:FE.;41E3
?@ R:<71EI.5:E3
?@ [E940I0753
V.770<F3W.513 OXY3:E3B1551E3 OXY3:E3B1551E3 OXY3:E3B1551E3 OXY3:E3B1551E3 ^:<133 \173 ?@ VD3A1.941E3 ^:<13 \173
?@ P[VDf3A1.941E3
?@ R8EE098/8G3T1I1/:;1E3
V.770<F3W.513 OXY3:E3B1551E3 OXY3:E3B1551E3 OXY3:E3B1551E3 OXY3:E3B1551E3 ^:<133 \173 ?@ VD3A1.941E3 ^:<13 \173
?@ h05<1773R:.943
?@ C;:E573R:.943
?@ W171.E941E3
Oi3 Oi3 ^:<13 ^:<13 Oi3 VE161E.=/L3 \17K3=853<:<M Z>@ B17535E.0<0<F3FE:8<236:E39.E11E73 [RRDVADT3CAjTD^AC3[WD3 b8E3;E:FE.G73.E13
fjPCC3.<23 fjPCC374.//3 0<3R0I0/3C1EI091K3h:E10F<3C1EI091K3 ^bA3[``bkDT3Ab3CfahA>3 ^bA3=:.E23
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./0123456789:8;:<9=>:?@: MANBO: =3\6:L9?D]6: G9?[3=6:B64=89_:UZR>_:ZRPP>: 48C9>6>0:
A@=69@3=?8@37:B=CD?6>:E2<ABF: PQRAPH0: 48C9>6>^: 3@D:A@=69@3=?8@37:R9]3@?`3=?8@>:
..0123456789:8;:<9=>:?@:G87?=?437: HS6IT=?8@: XC>=:L6:=56?9: a01 HS46776@=:T96T393=?8@:?@:
H48@8IJ:E2<GHF: ;89:U8@V MANBO: TC9>C?@]:23456789:8;:b3c>:Ebb2F:
.K0123456789:?@:GCL7?4: QWXBBY: PQRAPH: 89:dC9?>:e84=89:EdeF0:
<DI?@?>=93=?8@:E2G<F:: Q8@89: MNRX:OQH: /01 R;;69>:]963=:8TT89=C@?=?6>:;89:
B=CD6@=:89: BO<NO: >458739>5?T>:?@:Z93DC3=6:
B=CD6@=: G98]93I>:?@:T96>=?]?8C>:
Z8[69@I6@=: W@?[69>?=?6>:5696:3@D:3L983D:
?060:X3>=69:8;:<9=>:3@D:
e84=893=6:e6]966>:EG50eF:
.01 26>=:=93?@?@]:]98C@D:;89:GCL7?4:
B69[?460:
.f0123456789:8;:B4?6@46:?@: hK: : hh: hh: hh: BOHX: U8: i1b3L893=89J:BCT69[?>89: U8:B5?;=?@]: U8:
G5J>?4>:E2BGQgF: i1H@[?98@I6@=:BCT69[?>89:
i1b3L893=89J:<>>?>=3@=:
i1j<:O6>=:H@]?@669:
i1B8;=c396:e6[678T69:
i1O93?@?@]:R;;?469:
i1X6D?437:G5J>?4?>=:
i1<43D6I?4?3@:
i1N6>6394569>:EG<Z<B<k:
:::GQAblRbPBk:
:::<eX<OHbk:
::GUNAF:
i1P8@>C7=3@=:
i1e3=3:<@37J>=:
.m0123456789:8;:B4?6@46:?@: hK: hK: hh: hh: hh: BOHX: U8: i1<43D6I?4?3@: U8:B5?;=?@]: g6>:
P56I?>=9J:E2BPQHXF: i1N6>6394569>:EGUNAkMUNAF:
i1b3L893=89J:BCT69[?>89:
i1P56I?437:O645@?4?3@:
i1n3=69:P56I?>=:
i1M896@>?4:P56I?>=:
i1G6=98:P56I?>=:
i1P56I?>=>:?@:?@DC>=9J:
ET69;CI6k;88DF:
i1j<:BCT69[?>89:
:
.h0123456789:8;:B4?6@46:?@: hK: hK: hh: hh: hh: BOHX: U8: i1<43D6I?4?3@: U8:B5?;=?@]: U8:
2?878]J:E2B2ARF: i1N6>6394569>:
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./01231456789:4;<=7>962997
./?1<=4@A7BC5@2C=7
./84;2CD4C=C643@7
7
7
7
EFG/H<;I9=C27CJ7K;495;97457LCC:7 PQ7 PQ7 PP7 PP7 PP7 KMR87 SC7 ./T53U9;@C27 SC7KI4J@4567 Z937
M9;I5C=C6A7NHKLMO7 ./V5<=A3@7
./?V78<5<6927
./LCC:7K<J9@A7WJJ4;927
./02C:1;@4C578<5<6927
./M9;I54;<=7K<=937CJ7LCC:7
02C;9334567
./M9;I54;<=7BC531=@<5@7
./V;<:9X4;4<57
./Y939<2;I9237NLSYTO7
7
Q[G/H<;I9=C27CJ7K;495;97457 PQ7 PQ7 PP7 PP7 PP7 KMR87 SC7 ./V;<:9X4;4<57 SC7KI4J@4567 Z937
S1@24@4C57<5:7>49@9@4;37 ./Y939<2;I9237
NHKS>O7 ./KUC2@7S1@24@4C543@7
./\9<=@I7BC<;I7
./B=454;<=7>49@4@4<57
./01D=4;7\9<=@I7S1@24@4C543@7
./S1@24@4C5<=7MI92<U43@7
./K;ICC=7S1@24@4C543@7
7
7
Q]G/H<;I9=C27CJ7K;495;97457 PQ7 PQ7 PP7 PP7 PP7 KMR87 Z937 ./V;<:9X4;4<57 SC7KI4J@4567 SC7
8<@I9X<@4;37NHK8VM\O7 ./Y939<2;I9237
./V;@1<2A7
./L45<5;4<=70=<55927
./T5^93@X95@7V5<=A3@7
./8<@I9X<@4;<=78C:9=927
./><@<7V5<=A3@7
./B2AU@C62<UI9237
7
Q_G/H<;I9=C27CJ7K;495;97457 PQ7 PQ7 PP7 PP7 PP7 KMR87 Z937 ./V;<:9X4;4<57 SC7KI4J@4567 SC7
VUU=49:78<@I9X<@4;37 ./Y939<2;I9237
NHKV08VM\O7 ./V;@1<2A7
./L45<5;4<=70=<55927
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./01234563157819:;457
./<95=3695>?9:7<@A3:3B7
./C9597819:;457
./DB;E5@FB9E=3B47
7
GHI/J9?=3:@B7@K7L?>31?37>17 PG7 PG7 PP7 PP7 PP7 LNQ<7 R@7 ./8?9A36>?>917 R@7L=>K5>1F7 R@7
L595>45>?47MJLLN8NO7 7 7 ./S3439B?=3B47
7 7 ./L595>45>?>917>17TB>2953791A7
7 U@23B16315701AV5B;7
./W>191?37844@?>9537
./8VA>5>1F7844@?>9537
./C9597819:;457
7
GXI/J9?=3:@B7@K7L?>31?37>17 TYTDQN7 PZ7 PZ7 PZ7 PZ7 78J<[7 7]QL7 ./ D@@E7NB9>13B7 71@137 71@7
D@@E3B95>2347MJLDO7 E9443B47 \Y<<L7 ./ D@@E7844>459157
./ ^KK>?37844>459157
./ D@@E7<919F3B47
GGI/J9?=3:@B7@K7L?>31?37>17 YEE3B7X_`7 PG7 PG7 PZ7 PG7 \Y<<L7 ]QL7 b7819:;457MQ?@1@6>?[7<9Bc3B7 R@137 R@7
Q?@1@6>?47MJLQO7 @K75=@437a=@7 S3439B?=O7
E9443A75=37 bJV4>13447Q?@1@6>?47d@VB19:>457
TYTDQN7 bJV4>13447Q?@1@6>457
7 b7D@BE@B9537T:9113B7
7 b7S3439B?=3B7
b0145BV?5@B7
7
GeI/J9?=3:@B7@K78B547>17\>45@B;7 TYTDQN7 PZ7 PZ7 PZ7 PZ7 \Y<<L7 ]QL7 bDVB95@B7 R@137 R@7
MJ8\O7 E9443B47 bD@::3F370145BV?5@B7
b78B?=>2>457
b\3B>59F37<919F3B7
bS3439B?=3B7
7
7
7
7
GfI/J9?=3:@B7@K7L?>31?37>17 YEE3B7X_`7 PG7 PG7 PH7 PG7 \Y<<L7 ]QL7 bE4;?=@635B>?>917 R@137 ]347
T4;?=@:@F;7MJLTL]O7 @K75=@437a=@7 b\S7844>459157
7 E9443A75=37 bD@::3F370145BV?5@B7
TYTDQN7 b\S7NB9>13B77
GPI/J9?=3:@B7@K78B547>17 TYTDQN7 PZ7 PZ7 PZ7 PZ7 \Y<<L7 ]QL7 b7C323:@E63157E:9113B7 R@137 R@7
L@?>@:@F;7M8JLO7 T9443B47 bRU^7a@Bc3B7
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
. .
/0121304510.
/678439:0.
/;:<=4>.4:?28<93?9.
.
.
.
.
@ABCD3451<:0.:E.F4=1?41.=?. ;M;N6G. OP. OQ. OP. O@. RDI. S12.T89.H829. VC W<=J59.R991?73?9. d:.25=E9=?J. d:.
G:80=2H.I3?3J1H1?9. ;322102. 93U1.T0=7J=?J. VC F5=X.F91Y307. d:.51=J59._1e8=01H1?9.
KDFGIL. 4:80212. VC G:80.Z8=71. f=95.;<132=?J.;102:?3<=9>.
VC G:80=2H.6?901X01?180.
VC G:80.[X1039:0.
VC M?=\102=9>.]?290849:0.
VC G03=?:0.
VC G:80.3?7.G03\1<.I3?3J10.
VC G03\1<.N:?28<93?9^R7\=210.
VC _1210\39=:?.F8X10\=2:0.
VC G=4U19=?J.F8X10\=2:0.
VC [X1039=:?2.I3?3J10.
VC G:80=2H.[EE=410.=?.̀ZMa.
_1J=:?.3?7.;0:\=?41.
VC b8H3?._12:8041.I3?3J10.
VC ;0:E122=:?3<.N:?J0122.
[0J3?=c10.K.;N[.L.
VC FX14=3<.6\1?9.I3?3J10.
VC N:0X:0391.R44:8?9.I3?3J10.
VC F3<12.3?7.I30U19=?J.
I3?3J10.
VC N:0X:0391.G03\1<.F8X10\=2:0.
VC N829:H10._1<39=:?2.I3?3J10.
VC ;8T<=4._1<39=:?2.I3?3J10.
VC R=0<=?1.N:8?90>.I3?3J10.
VC N829:H.3?7.N30J:.]?2X149:0.
VC b:91<.W8?49=:?.I3?3J10.
VC G03\1<.I3J3c=?1.67=9:0.
VC N3<<.N1?910.F8X10\=2:0.
VC R=0<=?1.;80210.
VC W::7.3?7.D1\103J1.I3?3J10.
VC _140139=:?.3?7.G51H17.;30U.
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./0/1234
56 .2278019:;0<2320=24>?/00234
56 @3/A2?9@3/B24C/834D31/08E234
56 F2G2/3=H234
4
IJK6L/=H2?;34;<4M=820=24804 >R>:S@4 TU4 TV4 TU4 TW4 XL.4 Y2G4Z[74O[G74 56 ]3;[0B4X7720B/074 d;4GH8<78014 d;4
@3/0GN;37/78;04 >/GG23G4 7/\24Z38B18014 56 >?/074F2=28A8019MH8NN8014 d;4H281H74F2e[832O2074
./0/12O2074PLM@F.Q4 =;[3G2G4 M[N23A8G;34 f87H4>?2/G8014>23G;0/?87`4
56 ^;18G78=4./0/12O2074
@3/80224
56 @3/0GN;374/0B4^;18G78=4
X==;[074S_2=[78A24
56 @3/0GN;374M23A8=24
:;;3B80/7;34
56 F2G23A/78;04M7/<<4
56 @3/0GN;374M[3A2`;34
56 S0732N3202[34
56 @3/0GN;374DN23/7;34
56 R08A23G87`4a0G73[=7;34
56 @3/80;34
56 @3/0GN;37/78;04./0/1234
56 @3/0GN;374
:;0G[?7/079XBA8G234
56 F2G23A/78;04M[N23A8G;34
56 @8=\278014M[N23A8G;34
56 DN23/78;0G4./0/1234
56 @3/0GN;374D<<8=234804^]Rb4
F218;04/0B4>3;A80=24
56 >3;<2GG8;0/?4:;0132GG4
D31/08E234P>:DQ4
56 @23O80/?4c8GN/7=H234
56 @3/0GN;37/78;04X==;[074
S_2=[78A24
56 M/?2G4/0B4./3\278014
./0/1234
56 :[G7;O234F2?/78;0G4
./0/1234
56 >[Z?8=4F2?/78;0G4./0/1234
56 X83?8024:;[073`4./0/1234
56 :/31;4M=H2B[?234
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./ 01234536789:63;<3457
./ =;3<7><::57?;@;2:A:@57
89:63;<3457
./ B345C3DE531@7FC:;7?;@;2:C7
./ B345C3DE531@7G<;@@3@27
F@;<H457
./ I9:C;531@478E9:CJ341C7
./ 0123453647G<;@@:C7
7
KLM/N;6O:<1C71P7863:@6:73@7 GTGUVW7 XY7 XL7 XY7 XZ7 FN?7 [:47DE57AE457 ./ 81E47UO:P7 d174O3P53@27 d17
Q14935;<35H7?;@;2:A:@57 GF88V=7 5;\:7DC3]23@27 ./ >11]7;@]7N:J:C;2:7 Q:32O57=:`E3C:A:@57F57<:;457
RN8Q?S7RP1CA:C<H7N8Q=?S7 61EC4:477 ?;@;2:C7 ZeZ7?;<:7
./ =:45;EC;@57?;@;2:A:@57 7ZeY7>:A;<:7
./ V^:6E53J:7Q1E4:\::9:C7 a35O7G<:;43@27G:C41@;<35H7
./ Q15:<7;@]7=:45;EC;@57
WC;3@3@27?;@;2:C7
./ V@5C:9C:@:EC7
./ =:41C57I9:C;531@47
?;@;2:C7
./ _356O:@7?;@;2:C7
./ 8;<:47?;@;2:C7
./ Q145:<7?;@;2:C7
./ U<ED7?;@;2:C7
./ GC1P:441C7
./ N;@`E:578E9:CJ341C7
./ >C1@57IPP36:78E9:CJ341C7
./ Q1E4:\::93@278E9:CJ341C7
./ Q:;]7a;35:C7
./ UO:P7]:7G;C53:bUO3:P7U11\7
./ VJ:@57G<;@@:C7
./ _356O:@78E9:CJ341C7
./ >11]7;@]7N:J:C;2:78:CJ36:7
F55:@];@577
./ N;C5:@]:C77
./ Q1E4:\::93@27F55:@];@577
./ >C1@57IPP36:7B:4\7U<:C\77
./ 851C:\::9:C77
./ _356O:@7U1AA344;CH7
./ U;D3@7UC:c77
./ F44345;@57N;\:C7
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
.
/0123456789.4:.;:<7=89>47:. /I. J0K. JIK. JIK. LLLLL. MNOPQBRO. SRQ. %4118#84 ZU.Q`;aB;Zb.. ZU.
?788@:4A9>47:.BCAD:767EF. 39>9.R:A7TC=. cC9T4:E.>7.N9ADC67=dW.3CE=CC.
G3;?BH. ?785@>C=.BCAD:4A49:. @57:.A7856C>47:.7<.5=7E=98.
;:5@>.U5C=9>7=.
;B.Q@557=>.Q>9<<.
?785@>C=.U5C=9>7=.
.9
V %412
18#84
39>9.?7:>=76.M:96FW>.
X@:47=.Y=7E=988C=.
ZC>[7=\.QFW>C8.Q@557=>.
.1
] %41^8"!254
QFW>C8W.M:96FW>.
QC:47=.Y=7E=988C=.
ZC>[7=\.Q5CA4964W>.
_WC=.Q@557=>.Q5CA4964W>.
/e123456789.4:.U<<4AC. /I. J0K. JIK. JIK. LLLLL. MNO.. FCW. %4118#84 ZU.Q`;aB;Zb.. ZU.
O9:9EC8C:>.BCAD:767EF. Q>C:7E=95DC=. cC9T4:E.>7.N9ADC67=dW.3CE=CC.
G3UOBH. R:A7TC=. @57:.A7856C>47:.7<.5=7E=98.
39>9fA7TC.75C=9>7=.
O4A=7A785@>C=.75C=9>7=.
BC=84:96.WFW>C8.75C=9>7=.
g7=T.5=7ACWW7=.
hCAC5>47:4W>.
N77\\CC5C=.
Y9F=766.?6C=\.
?966.?C:>C=.MEC:>.
Q96CW.hC5=CWC:>9>4iC.
Q96CW.?6C=\
9
V %412
784!&j34!
18#84
OCT4A96.B=9:WA=45>47:4W>.
OCT4A96.QCA=C>9=F.
OCT4A96.?6C=\.
OCT4A96.hCAC5>47:4W>.
MT84:.MWW4W>9:>.
X@:47=.QCA=C>9=F.
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
./01/23145
678125.2/97:13;</15
=/:3>5./01/23145
?30<@9/5.2/97:13;</15
?30<@9/5A139B01@;2@79@B25
678125A139B01@;2@79@B25
5
C1%41D8"!254
EF/082@G/5./01/23145
.8;/1G@B715
HI5?393:/15
JKLMN@;>7O35@9567O;82/15 JR5 STU5 SRU5 SRU5 VWX5 .AE?5 Y/B5 %4118#84 VZ5.HabAaVc55 V75
E9:@9//1@9:5A/0<97>7:45 67O;82/15I/;3@15.<7;5XBB@B23925 =/3`@9:5275d30</>71eB5N/:1//5
PN6EAQ5 67O;82/15A/0<9@0@395 8;79507O;>/2@7957f5;17:13O5
67O;82/15Z;/132715
.4B2/O5.8;;7125A/0<9@0@395
[89@71567O;82/15./1G@0/5A/0<9@0@395
59
\ %412
18#84
./9@71567O;82/15./1G@0/5A/0<9@0@395
67O;82/15]/1@;</13>5A/0<9@0@395
51
C %41D8"!254
67O;82/15E9:@9//15XBB@B23925
67O;82/15.4B2/O5N/B@:9/15
XBB@B23925
./9@715]17:13OO/15
^/_5N/B@:9/1WN/G/>7;/15
^/_5X`O@9@B2132715
.4B2/O5X`O@9@B2132715
67O;82/15A13@9/15
.4B2/O5I/B/310</15
A/0<9@03>5.8;;7125
.8;/1G@B71W?393:/15
JgLMN@;>7O35@95?/0<39@03>5 JR5 STU5 SRU5 SRU5 VWX5 .AE?5 Y/B5 %4118#84 VZ5.HabAaVc55 Y/B5
E9:@9//1@9:5A/0<97>7:45 XBB@B23925X827O72@G/5?/0<39@05 =/3`@9:5275d30</>71eB5N/:1//5
PN?EAQ5 XBB@B23925X8275E>/021@0@395?/0<39@05 8;79507O;>/2@7957f5;17:13O5
XBB@B23925?30<@9/5.<7;5A/0<9@0@395
XBB@B23925^/>`/15
5
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
.9%412
18#84
/0123214567869:;<497
=6>?6@7
A<?0B1@4;>7869:;<497
/4@C92<?4142<4<D7E69:<494;<7
/4@C92<?4142<4<D7A<B1;>>6@7
F;@7/4@CF2<7E69:<494;<7
7
G1%41H8"!254
/0123214567F:46I7869:;<497
/4@C92<?4142<4<D7A<B1;>>6@7
/012321456J/4@C92<?4142<4<D7
F2<1@;912@7
8;9:4<67K:2L7
E69:<494;<JK0L6@54B2@7
KM4>>6?7N@2I6BB42<;>7=6>?6@7
K;I61O7869:;<49;>7E69:<494;<7
PPQRS4L>23;74<7T>691@49;>7 PW7 XYZ7 XWZ7 XWZ7 [J/7 KET87 \6B7 %4118#84 [_7K`A^EA[a77 \6B7
T<D4<66@4<D7E69:<2>2DO7 /BB4B1;<17T>691@494;<7 b6;?4<D7127];9:6>2@cB7S6D@667
USTTEV7 /BB4B1;<17]04>?4<D7T>691@494;<7 0L2<7923L>6142<72I7L@2D@;37
/BB4B1;<17A<?0B1@4;>7T>691@494;<7
T>691@49;>7S@;I1B3;<7
7
.9%412
18#84
T>691@494;<7
T>691@49;>7S@;I1B3;<7
]04>?4<D7T>691@494;<7
A<?0B1@4;>7T>691@494;<7
71
G %41H8"!254
T>691@49;>7^2@63;<7
T>691@49;>7TB143;12@7
]04>?4<D7T>691@494;<7
T>691@49;>7F2<1@;912@7
A<?0B1@4;>7T>691@494;<7
PdQRS4L>23;74<7T>691@2<49B7 PW7 XYZ7 XWZ7 XWZ7 [J/7 KET87 \6B7 %4118#84 [_7K`A^EA[a77 \6B7
F2330<49;142<B7 e;?42JEf7E69:<494;<7 b6;?4<D7127];9:6>2@cB7S6D@667
T<D4<66@4<D7E69:<2>2DO7 T>691@2<49B7/BB63g>6@7 0L2<7923L>6142<72I7L@2D@;37
USTFTEV7 h0<42@7T>691@2<49B7K6@54967E69:<494;<7
h0<42@7e;?42JEf7E69:<494;<7
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
.9
/ %412
18#84
012345341463.74389:4.;3<89=43.
7419<3.0>4:23<19:.74389:4.?4:@19:9A1.
7419<3.BA=9<C?D.?4:@19:9A1.
E6A>92F.GHH63A1:4.?4:@19:9A1.
E6A>92F.I<123<>>4=.?4:@19:9A1.91.
D9=4<.
0>4:23<19:H.I<1H6J43.;3<=6:2.
GHH4JK>43.A1=.L1H2A>>43.
.
M1%41N8"!254
0>4:23<19:HCI<JJ619:A29<1H.
?4:@1<><O9H2.
0>4:23<19:H.I<JJ619:A29<1H.
L1H2A>>43.
01O9144391O.GHH9H2A12.
?4H2.01O9144391O.?4:@19:9A1.
G55>9:A29<1.01O9144391O.?4:@19:9A1.
;3<:4HH.01O9144391O.?4:@19:9A1.
012345341463.74389:4.;3<89=43.
0>4:23<19:H.I<JJ619:A29<1H.
?4:@1<><O9H2.
PQRST95><JA.91.I989>. PW. QXY. QWY. QWY. ZCG. 7?0[. \4H. %4118#84 Z_.7`La?LZb.. \4H.
01O9144391O.?4:@1<><OF. I989>.41O9144391O.24:@1<><O9H2HC. ]4A=91O.2<.cA:@4><3dH.T4O344.
UTID0?V. 24:@19:9A1H. 65<1.:<J5>429<1.<e.53<O3AJ.
IA32<O3A5@43H.
]A1=.H6384F<3H.
IGT.<543A2<3H.
.
/9%412
18#84
I989>.41O9144391O.24:@19:9A1.
IGT.<543A2<3.
01O9144391O.H6384F<3.
T4H9O1.24:@19:9A1.
.
M1%41N8"!254
GHH9H2A12.[A1AO43.
I<1H236:29<1.7924.GHH9H2R.7654389H<3.
0^4:62984.01O91443.
E6A>92F.I<123<>.01O91443.
 8!!4"
789
 4""!849
00
 789
 789
 789
 789
 #12521
21 14 14 14 14 4!839 149 -24121
0123145 81  8974 8989 89
93!8 149 $%&'2( )2*+""21988 541, $%&'2(
.
/0123456789.4:.;946<9=. /E. FGH. FEH. FEH. IJK. LB>M. N@O. %4118#84 IS.L\U]BUI^.. N@O.
>:?4:@@A4:?.B@CD:767?=. P4Q46.>:?4:@@A4:?.B@CD:767?4OROJ. _@9`4:?.R7.a9CD@67AbO.3@?A@@.
. B@CD:4C49:O. W57:.C7856@R47:.7[.5A7?A98.
PK3.S5@A9R7A.
TKJ.TP.U:O5@CR7A.
.
V9%412
18#84
PK3.S5@A9R7A.
>:?4:@@A4:?.LWAQ@=7A.
;946.M94:R@:9:C@.B@CD:4C49:.
TW9:R4R=.LWAQ@=7AO.
TKJ.TP.U:O5@CR7A.
X1%41Y8"!254
.
Z69::4:?.>:?4:@@A.
TW964R=.P7:RA76.>:?4:@@A.
BA94:.3A4Q@A.
;946<9=.P9A.B@CD:4C49:.
;946<9=.L9[@R=.>:?4:@@A.
.
.
 Republic of the Philippines
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Attachment A
Office of the President Executive Vice President for Academic Affairs
College of Architecture and Fine Arts

FRESHIES APPLICATION FORM AY 2020-2021

Name: ____________________________________________________ Date: _____________________________

Surname First Name Middle Name

Age: ____________ Gender:_____________ Religion:______________________

TRAITS (please rate yourself) Excellent (90 Very Good (85- Good (80-84) Needs Improvement
and above 89) (75-79)

A. Interest in Chosen Course (Level of

interest to thee course inspirations, background
knowledge about the course)

B. Communication Skills (Ability to express

ideas and convictions. Pronunciation, diction and
comprehension)

C. Personality. ( Attitude, Values, Grooming,

Etiquette, and Presence/Poise)

D. Honors/Awards received in High School (Curricular, Co-curricular and Extra-curricular):

_____________________________________________________________________________
E. Special Skills (Sports, Technology, Practical Skills, Arts, Drafting, Etc..)
_____________________________________________________________________________
F. Career Choice Decision: ____ Self ____ Parents ____ Others,who? ______________________________
G. Course preference: 1st____________________ , 2nd____________________ , 3rd____________________ .

The following questions are asked not as a basis of your acceptance in the program but will allow the college to determine how
the learning instructions could be delivered to you more efficiently and effectively.

H. Do you have a computer at home? Yes ____ No ____

If yes is it personal or shared with other members of the family ____ personal ____ shared _______ # of people sharing

I. Do you have an internet connection Yes ____ No ____

J. What type ____ data from phone ____ pocket wifi ____ cable/fiber optic

I hereby certify that all the drawings submitted as part of admission requirements of the College of Architecture and Fine
under the program of BS Architecture ____ / BS Interior Design ____ and the aforementioned information were personally
executed and accomplished without any assistance from other persons.

__________________________________
Applicant’s Signature over Printed Name
Date

Anonas cor Pureza Streets, Sta. Mesa, Manila 1016

Direct Line: 8713-9304|
Website: www.pup.edu.ph | Email: cafa@pup.edu.ph
THE COUNTRY’S 1st POLYTECHNICU
01234
 6786879
8432
439
84  

!!"#$%&   &"#"#$9'!
&(" &)"#* 
+,-./012-34+05/6/57/0
895/01:;-<=0>?@