REGISTRATION DATA SHEET CAPITAL STOCK/INCORPORATORS/DIRECTORS/OFFICERS INFORMATION (FOR DOMESTIC STOCK CORPORATION ONLY) SEC NUMBER
FILL UP INSTRUCTIONS:
Type or print legibly. Light -shaded boxes are to be filled up by SEC, including the SEC number. For no-par stockds, leave the authorized capital amount and the par value columns blank.
COMPANY NAME
COMPANY TIN
CAPITAL STRUCTURE SHARE CODE
PAID -UP CAPITAL
SHARE TYPE
AUTHORIZED PAR P/N VALUE
NO. OF SHARES
CASH
AMOUNT
SUBSCRIBED CAPITAL NO. OF AMOUNT SHARES
F/N
PROPERTY
PAID-UP
PAID
AMOUNT
IN
OTHERS
TOTAL
BY ASSET TYPE
-
INCORPORATORS / STOCKHOLDERS / DIRECTORS / OFFICERS (Use additional sheets if necessary) NAME (Company Name, if company) (Last Name, First Name, MI, Maiden Surname, if person)
TAXPAYER IDENTIFICATION NUMBER
BIRTH DATE
CODE
NATIONALITY
BRD
INC'R
OFR
SHARE CODE
SHARE TYPE
SUB-TOTALS
NO. OF SHARES
SUBSCRIBED CAPITAL
PAID-UP CAPITAL
-
-
-
Note: For codes to use in filling up the columns, refer to the last page of this form. Refer also to the back of this page for additional instructions.
Page 3 of 3
RDS 96-1DS
REGISTRATION DATA SHEET CAPITAL STOCK/INCORPORATORS/DIRECTORS/OFFICERS INFORMATION (FOR DOMESTIC STOCK CORPORATION ONLY)
SEC NUMBER
FILL UP INSTRUCTIONS:
FOR SEC TO PROVIDE: MAINTENANCE NO.:
TRANSACTION DATE
Type or print legibly. Light -shaded boxes are to be filled up by SEC, including the SEC number.
COMPANY NAME
INCORPORATORS / STOCKHOLDERS / DIRECTORS / OFFICERS (Use additional sheets if necessary) NAME (Company Name, if company) (Last Name, First Name, MI, Maiden Surname, if person)
NO. OF DIRECTORS:
TAXPAYER IDENTIFICATION NUMBER
CODE
NATIONALITY
BRD
NO. OF STOCKHOLDERS:
INC'R
OFR
SHARE CODE
SHARE TYPE
SUBSCRIBED CAPITAL
TOTALS
PAID-UP CAPITAL
-
-
FOREIGN EQUITY BREAKDOWN (Refer to the back of this page for instruction on how to fill-up this section.) NATIONALITY CODE
TOTAL FOREIGN EQUITY
NATIONALITY DESCRIPTION SUBSCRIBED CAPITAL OF -INDIVIDUALS COMPANY (IES) PAID UP CAPITAL OF -INDIVIDUALS COMPANY (IES) TOTAL PAID-UP CAPITAL PERCENTAGE OF FOREIGN EQUITY CERTIFIED CORRECT:
(Signature over printed name)
POSITION:
DATE:
PROCESSING ATTORNEY:
PROCESSING EXAMINER:
DATA CONTROL CLERK:
DATA ENCODER:
DATE REVIEWED:
DATE REVIEWED:
DATE REVIEWED:
DATE ENCODED:
INSTRUCTIONS FOR FILLING UP THE FOLLOWING COLUMNS: PAR/NO PAR (P / N) FILIPINO / FOREIGN VALUE INDICATOR (F/N) OWNED P - PAR INDICATOR -N - NO PAR F - FILIPINO N - NON-FILIPINO / FOREIGNER
WITH PAID-IN SURPLUS? Y - YES N - NO
BOARD (BRD) INDICATOR -C - CHAIRMAN M - MEMBER N - NEITHER
OFFICER (OFR) INDICATOR -PRE - PRESIDENT CEO - CHIEF EXECUTIVE OFFICER CFO - CHIEF FINANCIAL OFFICER COO - CHIEF OPERATING OFFICER COS - CORPORATE SECRETARY
LEG - LEGAL COUNSEL AUD - EXTERNAL AUDITOR GOV - GOVERNMENT REPRESENTATIVE OTH - OTHERS N - NONE
REGISTRATION DATA SHEET GENERAL / BUSINESS / COMPANY RELATIONSHIP INFORMATION (FOR DOMESTIC COMPANIES ONLY) SEC NUMBER FILL UP INSTRUCTIONS
Type or print legibly. Light-shaded boxes are to be filled up by the SEC. Check appropriate boxes. FILL UP ONLY THOSE ITEMS FOR WHICH AMENDMENTS OR CHANGES ARE TO BE MADE. Refer to the back of this page for additional instructions.
COMPANY NAME GENERAL INFORMATION
(
) DS - DOMESTIC STOCK
( )DN - DOMESTIC NON-STOCK
CHANGE FROM STOCK TO NON
( ) DP - DOMESTIC PARTNERSHIP
PRINCIPAL OFFICE ADDRESS AREA CODE
POSTAL CODE
TEL. NO.
FAX NO.
POSTAL CODE
TEL. NO.
FAX NO.
BUSINESS OFFICE ADDRESS AREA CODE BUSINESS INFORMATION PARTNERSHIP
TYPE OF ENTERPRISE LIMITED
[
]
[
] GENERAL
INDUSTRY CODE
TERMS OF EXISTENCE
[
]
N- NO SPECIAL REGISTRATION
[
]
H- FIA HOLDING
[
]
E - FIA EXPORT
[
]
R - FIA REPRESENTATIVE OFF
[
]
D - FIA DOMESTIC
[
]
S - SUBIC REGISTERED
FISCAL YEAR END (MM/DD)
ANNUAL MEETING (For Domestic Companies only)
YEARS
( )
TYPE OF NON STOCK CORPORATION (Refer to the back of this page for the classification)
F - FIXED (MM/DD)
TOTAL CONTRIBUTION (of domestic non-stock companies)
[
]
% OF FOREIGN M
COMPANY RELATIONSHIP - List all companies related to the registrant. (Use additional sheets, if necessary) RELATIONSHIP TYPE
C
- DISSOLVED COMPANY ( if due to consolidation)
(RELN TYPE)
V
- DISSOLVED COMPANY ( if change in company type)
RELN TYPE
CERTIFIED CORRECT:
SEC NUMBER
S - PARENT COMPANY (if registrant is a subsidiary) A - AFFILIATE (of registrant) TIN
(Signature over printed name)
COMPANY NAME
POSITION:
DATE:
PROCESSING ATTORNEY:
PROCESSING EXAMINER:
DATA CONTROL CLERK:
DATE REVIEWED:
DATE REVIEWED:
DATE REVIEWED:
CHANGE FROM STOCK TO NON ( ) YES
CHANGE IN PRIMARY
( )X YES
FAX NO.
FAX NO.
A HOLDING
[
]
F - FINANCIAL INSTITUTION
IA REPRESENTATIVE OFF
[
]
Z - EPZA REGISTERED
UBIC REGISTERED
[
]
B - BOI REGISTERED
TING (For Domestic Companies only) V - VARIABLE ____________________ % OF FOREIGN MEMBERSHIP (Of non-stock companies)
