WALTERMART COMMUNITY MALLS

8/F Waltermart Building, 8001A EDSA,

Brgy. Veterans Village, Quezon City

TENANT INFORMATION SHEET

Please accomplish this form upon receipt OR fax to +632 332-1132 or +632 8981-0026 as soon as possible in
order to facilitate the processing of the lease contract/amendment.

(1) NAME OF LESSEE

(To be indicated in the lease contract) :_ :
________________________________________________________ (2) TRADE NAME/S
(Business Name) :________________________________________________________
(3) MALL/S :________________________________________________________
(4) FORM OF BUSINESS : ( )( ) Sole Proprietorship ( ( ) ) Partnership ( ( ) )
Corporation
(5) TAX IDENTIFICATION NO. :_:
________________________________________________________ (6) FRANCHISEE
: ( )( ) Yes ( ( ) ) No
(7) OFFICIAL ADDRESS OF LESSEE :_ :
________________________________________________________ (8) AUTHORIZED SIGNATORY
OF CONTRACT :_ :
________________________________________________________
(8a) Position Title :_ :
________________________________________________________
(8b) Residence Address :_ :
________________________________________________________
:________________________________________________________
(8c) Contact Number/s :_ :
________________________________________________________
(8d) Tax Identification No. :________________________________________________________
(8e) Social Security No. (SSS) :_ :
________________________________________________________
(9) NAME OF AUTHORIZED REPRESENTATIVE
(If different from authorized signatory) :_ :
________________________________________________________
(9a) Email Address :_ :
________________________________________________________

By signing this form, I hereby give my express, unconditional, voluntary and informed consent to WM Shopping Center
Management, Inc,,its parent company, subsidiaries, affiliates, related corporations, partners and service providers, if any, to collect,
record, store, modify, use, consolidate, share or otherwise process my personal data for the purpose of entering into a lease
agreement with you, complying with and/or enforcing the obligations under such lease agreement, improving our services, and other
legitimate business purposes, for the period allowed under applicable laws and regulations. I further warrant that I am authorized to
disclose and have secured the necessary consent of the personal data of other data subjects which I may have specified herein.
 (9b) Telephone Number :_ :
________________________________________________________
(9c) Fax Number :_ :
________________________________________________________
(9d) Mobile Number :_ :
________________________________________________________

CERTIFIED CORRECT BY: DATE:

_____________________________ ___________________________
AUTHORIZED REPRESENTATIVE

By signing this form, I hereby give my express, unconditional, voluntary and informed consent to WM Shopping Center
Management, Inc,,its parent company, subsidiaries, affiliates, related corporations, partners and service providers, if any, to collect,
record, store, modify, use, consolidate, share or otherwise process my personal data for the purpose of entering into a lease
agreement with you, complying with and/or enforcing the obligations under such lease agreement, improving our services, and other
legitimate business purposes, for the period allowed under applicable laws and regulations. I further warrant that I am authorized to
disclose and have secured the necessary consent of the personal data of other data subjects which I may have specified herein.