BANBROS COMMERCIAL INC.

BB Corporate Center, No. 32 Pilar cor. Araullo Streets

Addition Hills, San Juan, Metro Manila, Philippines
Trunkline (02) 8705-1797

STRICTLY CONFIDENTIAL

DEALERS INFORMATION SHEET

I. GENERAL INFORMATION

Business Name Tax Identification No.

Address
Telephone No/s. Fax no. Email Address:
Ownership ( ) Owned ( ) Rented Years of Stay:
Warehouse Address
Telephone No/s. Fax No.
Branches, if any:
Nature of Business
Years in Operation
Registration Registration Body Registration no. Approval Date
( ) Securities and Exchange Commission
( ) Department of Trade and Industry
( ) Business Permits & Licensing Office

Affiliates:

Principal Officers Name Contact Number Signature

President/CEO
Accounting Manager
Purchasing Officer

Major Suppliers Address Telephone Number Contact Person Terms

Customers Address

Bank References - Name/Branch Current Account Number Telephone Number Contact Person

II. OWNER'S CREDIT INFORMATION (For sole proprietorship)

Name of Registered Owner: Date of Birth:

Residence Address:
Ownership ( ) Owned ( ) Rented Years of Stay:
III. AUTHORIZED SIGNATORIES

Printed Name
Signature

I hereby certify that the foregoing information is true and correct.

Signature over Printed Name Date

Please submit the following documents together with this application form.
1. Articles of Incorporation and By-laws
2. DTI Registration (Business Name) for sole proprietorship
3. Business Permit/Mayor's Permit
4. BIR 2303 (BIR Registration)
5. Authorization to Verify Bank History (please see 2nd page)
6. Financial Statements for the last 2 years
7. Bank Statements for the last 3 motnhs
8. Company Profile
 BANBROS COMMERCIAL INC.
BB Corporate Center, No. 32 Pilar cor. Araullo Streets
Addition Hills, San Juan, Metro Manila, Philippines
Trunkline (02) 8705-1797

STRICTLY CONFIDENTIAL

AUTHORIZATION TO CONDUCT CREDIT / BACKGROUND INVESTIGATION

Dear Sir / Madam,

I hereby authorize BANBROS COMMERCIAL INC. or its duly authorized representative

to conduct a credit investigation regarding our bank account with the details below:

Account Name:
Account Number:

This authorization is being issued for Dealer Accreditation purposes only.

I hereby certify that the foregoing information is true and correct.

Authorized Signatory Date

* please fill up another form if you have more than one (1) bank account