APPLICATION FORM

I. COMPANY INFORMATION

Last Name First Name Middle Name

LETABA LOLIT LIM
Name of Business / Store / Outlet :

Home / Office Address:

13-7 WHITE HILLS SUBDIVISION, SOUTH ROAD, BANAWA, CEBU CITY, 6000
Contact Information :
Telephone No. : 032-233=-2996 Mobile Nos. : 0917-318-1955 Fax No.

E-mail Address : lolitlimletaba@worldtrex.net Website (if applicable) :

For Single Proprietorship: For Corporation / Partnership:
Tax Identification No. (individual) Tax Identification No. (individual) 122-432-023-000
Community Tax Cert. No. (individual) Community Tax Cert. No. (individual)

If Corporation / Partnership:
Name of Partner / Incorporators Title/ Designation Name of Partner / Incorporators Title/ Designation
1. RAFAEL L. LETABA GENERAL MANAGER 4.
2. RICHARD REYAN L. LETABA COO 5.
Nature of the Business:

List of Other Branches (if applicable) :

Location Products Average Monthly Sales Years in Business

CEBU 26
MANILA 10

Other Business:

Contact Person Other than the Owner (if any) Designation of Contact Person: Primary Contact number
JOHNNA MARIE H. TEE MANAGER 0917-553-1069

II. LOCATION REQUESTED: The Outlets Al Fresco / Exhibit Areas iMEZ Building The Persimmon Plus West Cebu Exchange (WCE)

III. APPLICATION DETAILS:

Proposed Business to be Operated (description):
General Concept of Business:
Specific Merchandise/Services to be Carried:
Specific Target Market:
How did you know about our Property? ( ) internet ( ) newspaper ( ) regular customer ( ) on the air ( ) invited by a friend
IV. ALTERNATE ADDRESSES:
a.) Home:

Address Contact Nos.

b.) Other Branches

Address Contact Nos.

UNIT 1611, CITY SOHO MALL, B. RODRIGUEZ, CEBU CITY 032-233-2996

V. OTHER REQUIREMENTS TO BE SUBMITTED:

1) Letter of Intent
2) Audited Financial Statement (if any)
3) For Franchise: Copy of Franchise Agreement & Endorsement Letter from Franchisor

I certify that the foregoing information is true and correct. This form is only for the purpose of applying for Space at Pueblo Verde. I am aware that is not
considered as a lease offer. Further, Pueblo Verde Leasing Office has the sole discretion to approve or reject this space application.

Signature over printed name Date