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