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Subdealer Application Form 3

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eddiebonganay13
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42 views

Subdealer Application Form 3

Uploaded by

eddiebonganay13
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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SUBDEALER APPLICATION FORM

GENERAL DETAILS OF BUSINESS CUSTOMER NUMBER:

Name of business :

Form of business : Sole proprietorship Partnership Corporation

Tax Identification No.: Business Style:

SEC / DTI Registration No. Business registration date :


Business address : Registered address :

City: Region: City: Region:

Telephone no. Fax no. Telephone no. Fax no.

Email Address:

Business Premise Occupancy Status Owned Rented If owned, is it free from encumbrances Yes No

DETAILS OF OWNER / SHAREHOLDERS / PARTNERS


Name TIN Residential address Shareholding (%)

DETAILS OF DIRECTORS / SENIOR MANAGEMENT


Name TIN Residential address Designation

BANK ACCOUNT DETAILS


Bank Name & Branch Contact Person & Number Account Type Account Number

TRADE REFERENCES
Company Name Contact Person Telephone No. Address

AUTHORIZED CHECK SIGNATORIES AUTHORIZED P.O. SIGNATORIES AUTHORIZED GOODS RECEIPT SIGNATORIES
Name Specimen Signature Name Speciment Signature Name Speciment Signature

CONTACT PERSON FOR THE PURPOSE OF: Corporation Partnership Sole Proprietor
SUPPORTING DOCUMENTS
COLLECTION STATUS INQUIRY Req'd Submt'd Req'd Submt'd Req'd Submt'd
Name Contact Number E-mail Address SEC Certificate of Registration
Owner's 2 Valid IDs
Latest GIS
Latest audited FS / ITR
DTI Certificate of Registration
ACCOUNT RECONCILIATION Mayor's Permit
Name Contact Number E-mail Address BIR Certificate of Registration
Organizational Chart
Office Vicinity Map / Shop Photo

DECLARATION BY SOLE PROPRIETOR OR CORPORATION

I / We , TIN acting on behalf of the abovementioned entity* hereby declare that the information above
is true and shall undertake to promptly inform you of any changes to the information supplied.

* the entity named in the "Name of business" section above. Signature over printed name
Designation :
Date :

TO FILLED UP BY RIC ACCOUNTING:


Reviewed By: Approved By:

Finance Head of Division, Aircon Dept Head of Division, Finance President

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