FRANCHISE APPLICATION FORM

This Application is kept Confidential by MR. LIEMPO AVENUE INC. Neither party is bound in any way by the submission of this
Application. Please submit this Application directly to MR. LIEMPO AVENUE INC. Fill out all required information and print all
answers clearly.

Date: ____________________

PERSONAL APPLICATION
Name of Applicant:
Citizenship: TIN: SSS No:
Home Address:

Home tel. no: Mobile Phone No: Email:

Business Address:
Office tel. no: Mobile Phone No: Email:

Date of birth: Marital status: No. of dependents:

Spouse’s name: Occupation: Contact No:

BUSINESS INTEREST

How did you become interested in a MR. LIEMPO franchise and why?

Where do you plan to locate the MR. LIEMPO store? (Please attach location/directional map and details regarding the site;
pictures or images if available:

Have you ever owned any interest in any restaurant, food cart or in any operations within the food service (restaurant) industry?
Yes ( ) No ( )

If Yes please give details:

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What percent of the proposed MR. LIEMPO franchise will you own? %.

Will you work in the business full time? Yes ( ) No ( ) If No, please explain.

Who will be responsible for the business day to day operations?

Will you have business partners? Yes ( ) No ( ) If Yes, please give name of each partner:

How will you finance the MR LIEMPO FRANCHISE business venture?

What is the source of this capital?

Have you ever been involved in any litigation or arbitration with respect to your previous business history?

Yes ( ) No ( ) If Yes, please explain:

EMPLOYMENT HISTORY
Please give your current and past employment experience: (Name of Employer, Position and Current Salary)

Have you ever worked in the foodservice industry? Yes ( ) No ( ) If Yes, when and where?

Have you ever been self-employed? Yes ( ) No ( ) If Yes, when, what business and where?

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EDUCATIONAL BACKGROUND
Please fill out where and when you graduated; school awards or honors, if applicable:

POSTGRADUATE :

COLLEGE :

HIGH SCHOOL :

GRADE SCHOOL :

The undersigned certifies that the information furnished in this Franchise Application is true and correct.
The undersigned understands that any misrepresentation in this Application may be grounds for the non-approval of any
Franchise Application or termination of any Agreement that will be the result of this Application.

APPLICANT:

NAME :

SIGNATURE :

DATE :

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