or PCCI Form R-3 SUPPLEMENTAL TRANSFER STATEMENT Foneecnsurrienea [RETURN TO PCCIIF NOT USED * ALL FEES SUBJECT TO CHANGE WITHOUT NOTICE PEGI Tnowouat Aecrereanion DOG'S NAME. srisrom must oe AS SHOWN ON FORW 82 ACCOMPAMNED BY PC ‘ron LITTER NUMBER AS SHOWN ON FORMA 2 SEC.C_ MUST BE COMPLETED IN FULL and SIGNED BY PERSON SELLING THIS DOG. (SELLen) —L (ve) certify that this dog was transfered DIRECTLY TO THE FOLLOWING PERSON(S) on PRINT NAME(S) OF PERSON(S) TO WHOM “ ~ “ DOG WAS DIRECTLY TRANSFERED ADDRESS. Signature een Signature SEC.D ‘TO BE COMPLETED and SIGNED BY PERSON(S) NAMED IN SECTION C ABOVE, PROVIDED the person (s) owns the dog atthe time this application is submitted to the PCL. If person(s) named in Sec, C has transfered the dog t another person(s) DO NOT COMPLETE SEC. D. Instead - use additonal form R-3. owe) hereby apply to the Philippine Canine Club, Ine. to have the Registration Certificate of this dog issued in my f our name (8) and certify that I (We) aogired it DIRECTLY fiom the person (s) who signed sec. C above, and that Ise) sill own this dog. I agree to abide by PCCI rules and regulations, NEW OWNER'S NAME NEW CO-OWNER'S NAME Signature Signatuce Address Address city city