Application Form | Dealer Owned Operating Platform

A great business opportunity?

You probably pass it every day.

Retailer Supply Agreement

Application Form

Shell is committed to delivering excellent customer service and our Retailers play a vital role. To help you achieve
this we will provide you with full training and support and will encourage you to look for every opportunity to use
your skills and talents. This is your opportunity to tell us as much as possible about yourself. It will help us to
make a fair decision to select the people who can naturally give excellent customer service. Please read the form
thoroughly, then complete it carefully and in your own handwriting or typewritten. Please ensure that you
complete ALL sections.

As a Retailer you are a self-employed, independent businessman/businesswoman.

If this application form is for a partnership or corporation, please decide who will be the contact person who will
complete this form.
Application Form | Dealer Owned Operating Platform

Date of Application:

Please click the box to

I. PERSONAL DETAILS upload your picture.

Last Name First Name Middle Name

Sex Date of Birth Birthplace Age Citizenship

Marital Status Number of Children Name of Spouse Occupation of Spouse

Current address (include postal code):

If you have lived for less than five years at your current residence, please provide your previous address(es) and
period of stay:

Home Telephone No. Mobile No. Business Telephone No. Email Address

Please list ALL geographical areas you would consider doing business in (in order of preference)

Do you live within ten (10) kilometers from your proposed site? ☐Yes ☐No
Do you hold a current driving license? ☐Yes ☐No
Are you prepared to do business 6 or 7 days a week if necessary? ☐Yes ☐No
Are you prepared to make a commitment to customer service if appointed? ☐Yes ☐No
Are you prepared to commit to the maintenance of strict health, safety and security environmental
☐Yes ☐No
standards if appointed?
Are you prepared to run the business within strict operating systems and controls? ☐Yes ☐No
Are you prepared to accept major credit cards? ☐Yes ☐No
Will you conduct your business in conformance to the Minimum Wage Law? ☐Yes ☐No
Have you ever been employed/engaged in a business in the oil industry? ☐Yes ☐No
If yes, where?
Have you ever held or are currently holding any position in local or national Government? ☐Yes ☐No
If yes, please provide the following details.
Name of Relative: Government position:
Applicant’s Relation to Relative and to what degree:
Other relatives:

Have you ever been employed by this company? ☐Yes ☐No

Are you related by affinity or consanguinity to any employee of this or any other oil company? ☐Yes ☐No
If yes, please provide details.
Have you ever been refused of any position by this company? ☐Yes ☐No
If yes, please provide details.
Application Form | Dealer Owned Operating Platform

II. EDUCATION AND EMPLOYMENT

Name of School Period of Attendance Degree Course Results Achieved

If currently self-employed:

Business/Company Name Brief description of products/services

Address:

Industry/business type Time dedicated to current business Estimated annual profit

(hours/week)

Main duties:

Period of operation Number of employees

If you currently run a business of your own, will it be your intention to continue with it? ☐Yes ☐No
Time dedication (hours/week)
If yes, who would run:
a) the current business: b) this new opportunity:

Other business/es (if any) Brief description

Please give details of your employment history starting with your current or most recent position or period of self-
employment. Please add an extra sheet if necessary.

Start and Address or Position, main duties, Monthly Reason for leaving or
End Dates Office/Company Telephone Number achievements Salary intended leaving
Application Form | Dealer Owned Operating Platform

Membership of professional bodies, grades, and qualifications:

Involvement in civic, people, business clubs or organizations:

III. CHARACTER ASSESSMENT

This section allows you to give us real life examples. Please tell us how you dealt with each of the following
situations below. What did you do, how did you do it and what happened? You can use examples from your work,
school, family life or your hobbies.

YOU MUST COMPLETE EACH SECTION. OTHERWISE, WE CANNOT PROCESS YOUR APPLICATION.

Please give an example of a time when you had to be patient and polite with an individual/group of people (e.g.
customer, workmate, friend) under difficult circumstances.

Please provide an example of when you have made an extra special effort to help somebody.

Describe a time when you had to use your initiative to succeed in getting something done properly and on time.

Please give an example of when and how you have managed to persuade someone to do something.
Application Form | Dealer Owned Operating Platform

Why have you chosen to apply to become a Retailer with Shell? Why are you suitable for this type of role?

IV. FINANCIAL DATA

NOTE: CREDIT CHECKING IS AN ESSENTIAL REQUIREMENT TAKEN THROUGH ALEADING LOCAL CREDIT
REFERENCE AGENCY. THIS MUST BE DONE AS PART OF THE APPLICATION PROCESS. PLEASE CONFIRM
YOUR AGREEMENT TO SHELL CONDUCTING ACREDIT CHECK IN ORDER TO PROGRESS YOUR
APPLICATION FURTHER BY SIGNING HERE:

Are you aware of any reason why you would be refused credit? ☐Yes ☐No
If yes, please give details:

Do you have or have pending any county court cases against you? ☐Yes ☐No
If yes, please give details:

What are your earning aspirations (gross earnings after costs and before income tax) over the next five years? (per
annum)

Please provide financing sources to fund investment requirement of Php 12M – 20M to fund a cluster of 1-2 sites?
Application Form | Dealer Owned Operating Platform

Income Statement
Income statement of the 12-month period ending:

Salary; Wages
Bonuses; Commissions
Dividends; Interest
Real Estate Income
Business Profit (Please specify)
Other Income (Please specify)
TOTAL INCOME

Statement of Net Worth

ASSETS LIABILITIES

Cash in the Bank Accounts, Notes & Loans

Payable
Securities/Bonds Real Estate and Mortgages
Payable
Accounts, Notes & Loans Other Liabilities
Receivable
Real Estate and Mortgages
Payable
Other Assets
TOTAL ASSETS TOTAL LIABILITIES
TOTAL NET WORTH (Total Assets minus Total Liabilities)

V. REFERENCE CHECKS

CONDITION OF TRAINING/CONTRACT: It is our intention to check all references and information offered by an
applicant on this application form. If it is found after checking that references and/or information provided by the
applicant are unsuitable or inaccurate then the applicant’s training/contract may be terminated without notice.

NOTE: A REFERENCE FROM YOUR CURRENT EMPLOYER WILL ONLY BE REQUESTED AFTER AN OFFER IS
MADE AND ACCEPTED.

Please supply details of three referees, one must be your current employer, or if self employed a previous employer or
a trade referee such as a bank manager, solicitor or accountant. If all three referees are not provided, this application
will not be considered. If self-employed, the references can also be personal.

Name E-mail Telephone Company Address

Application Form | Dealer Owned Operating Platform

VI. DECLARATION

Do you have any unspent criminal convictions for offences of theft or dishonesty, or do you have
a case pending for offences of theft or dishonesty? ☐Yes ☐No

If yes, please provide details:

I hereby declare that all the information given by me and in this application form is true and I agree that Pilipinas Shell
Petroleum Corporation may seek confirmation from appropriate sources. If at any time the information is found to be
false or in any way incorrect, any contract between myself and Pilipinas Shell Petroleum Corp is likely to be terminated
without notice.

Signed:

IT IS ESSENTIAL YOU SIGN AND DATE THIS FORM – THANK YOU.

VII. SOURCE

Please be kind enough to indicate how you became aware of the position of Retailer by ticking one of the
following boxes.
☐ ADVERTISEMENT - Please indicate name of publication/website:
☐ SHELL RETAILER RECOMMENDATION - Please indicate Retailer's name:
☐ SHELL TERRITORY MANAGER - Please indicate name:
☐ OTHER RECOMMENDATION - Please indicate source:
☐ SPECULATIVE

VIII. DATA PROTECTION

1. Shell uses the information the Retailer and/or Applicant provides (1) to operate the Retailer’s account and any
agreement with Shell; (2) to confirm, update and enhance Shell’s customer records; (3) to establish any
Retailer and/or Applicant’s identity; (4) for general statistical analysis; (5) to record and consider the Retailer’s
and/or Applicant’s criminal convictions or alleged commission of an offence; and (6) to assess the Retailer’s
and/or Applicant’s credit status (for this purpose, credit scoring techniques will be used and checks may be
carried out with a credit reference agency and a fraud detection system, which will maintain a record of any
such enquiry).

2. Shell may disclose data relating to the Retailer/Applicant to (1) a credit reference agency where it may be
accessed by other financial institutions to assist assessment of any application for credit made to Shell and for
occasional debt tracing and fraud prevention; (2) any agent or sub-contractor of Shell; (3) any supplier of the
Retailer; (4) any person to whom Shell proposes to transfer any of its rights and/or duties under the
Agreement; (5) any guarantor or person providing security in relation to the Retailer’s obligations under any
agreement with Shell; (6) any third party to which the Retailer owes monies, or is alleged to owe monies, in
connection with the operation of the Business; (7) other companies in the Shell group of Companies in the
Philippines; (8) other parties as may be notified to the Retailer by Shell from time to time; (9) as otherwise
required or permitted by law or any regulatory authority.
Application Form | Dealer Owned Operating Platform

3. By Signing this Application form, the Retailer and/or Applicant explicitly hereby consents to the use of their
information for the purposes in these paragraphs and to the Privacy Notice provided at
https://www.shell.com.ph/privacy/b2b-notice.html, and all its amendments thereto.

Signed:

4. Shell may use information about the Retailer and/or Applicant to send the Retailer and/or Applicant information
about other goods and/or services offered by Shell and/or by third parties (including companies in the Royal
Dutch/Shell Group) which Shell believes may be of interest to the Retailer and/or Applicant. Shell may also
provide details of a Retailer or Applicant’s name, address and other information as part of a mailing list to third
parties (including companies in the Royal Dutch/Shell Group) to enable them to market goods and/or services
which Shell believes may be of interest to the Retailer/Applicant. Retailers and/or Applicants may be contacted
about other goods and services by any means (including telephone and e-mail).

Please tick this box if you do not wish to receive this information: ☐