GENERAL INFORMATION SHEET

STOCK CORPORATION
PLEASE PRINT LEGIBLY

CORPORATE NAME: SUCCESSU INTERNATIONAL INC.

IOTAL NUMBER OF STOCKHOLDERS;

IOTAI ASSf,TS BASED ON LITTEST AUDITED FS:

STOCKHOLDER'S INFORMATION

SHARES SUBSCRIBED

NAME, NATIONALITYAND CURRENT o/o AMOUNTPAJD TAX IDENTIFICATION

OE
RESIDf,NTIAL ADDRESS AMOUNT (PhP) NUMBER
TYPE NUMBER OWNER.
(PhP)
SHIP

15.

TOTAL

16.

TOTAL

77.

TOTAL

18.

TOTAL

19.

TOTAL

20.

TOTAL

21. OTHERS {lndicate the num}rer of the remaininS

stockhalders)

TOTAL

TOTAL AMOUNT OF SUBSCRIBED CAPITAL 0.00o/o

o.00
TOTAI AIIIOUNT OF PAID.UP CAPITAL

INSTRUCTIoN: SPECIFY THE'lOP 20 STOCXHOLDERS AND INDICATE THE REST AS OTHERS

lote: For PDTC Nominee included in the list, please indicste lurther the benefrcial omqs owing more than 5o/o of sny class of the company's voting seerities, Attach
tPnoratc sh?ct. if nPaPsso D-

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