Sei sulla pagina 1di 2
PHILIPPINE BUSINESS REGISTRY SEC-REGISTERED COMPANIES APPLICATION FORM A. SEC REGISTRATION INFORMATION 1. Business Type

PHILIPPINE BUSINESS REGISTRY SEC-REGISTERED COMPANIES APPLICATION FORM

A. SEC REGISTRATION INFORMATION 1. Business Type (Please select one.)  Stock Corporation  General
A.
SEC REGISTRATION INFORMATION
1.
Business Type
(Please select one.)
 Stock Corporation
 General Partnership
 Non-Stock Corporation
 Limited Partnership
 Foreign Non-Stock Corp
 Foreign Partnership
 Foreign Stock Corporation
 Professional Partnership
2.
SEC Registration No.
3.
SEC Registration Date
4.
TIN (pre-generated issued by SEC)
5.
Company Name
B.
BUSINESS DETAILS
6.
House/Building No.
7.
House/Building Name
8.
Street
9.
Barangay
10.
Town/C
ity
11.
Province
12. Region
13.
Phone No.
(Please put in area code)
14.
Fax. No. (Please
put in area code)
15.
Mobile No.
16.
eMail Address
C.
PSIC and Other Details
17.
Business Activities
(Please check all that applies)
 Manufacturer/Producer
 Service
Retailer
 Importer
Exporter
 Wholesaler
18.
Main Business Activity (Select one among
the business activities you chose above)
 Manufacturer/Producer
 Service
Retailer
 Importer
Exporter
 Wholesaler
19.
Indicate Main Product Handled/
Service Rendered
20.
Total No. of Employees
D.
DOING BUSINESS AS (List down company names and please use another form if more than 5 )
E.
INCORPORATOR/PARTNER DETAILS (At least 2 is required. If more than 2 incorporators, use another application form)
MAIN INCORPORATOR/PARTNER
21.
Position/Title:
23.
Middle name:
22.
First Name:
24.
Last Name:
25.
Suffix:
26. SSS Number:
27.
Pag-ibig Number:
28. TIN:
29. House/Building No.

Page 1 of 2

30. House/Building Name

   

31. Street

   

32. Barangay

   

33. Town/C

 

ity

 

34. Province

   

35.

Region

 

PARTNER/OTHER INCORPORATOR

 

36.

First Name:

 

37.

Middle name:

 

38.

Last Name:

 

39.

Suffix:

 

40.

SSS Number:

 

41.

Pag-ibig Number:

   

42.

TIN:

43.

House/Building No.

 

44.

House/Building Name

 

45.

Street

 

46.

Barangay

   

47.

Town/C

ity

 

48.

Province

   

49.

Region

 

F.

AUTHORIZED REPRESENTATIVES (At least 1 is required. If more than 2 representatives, use another application form)

Representatives Details

 

50.

First Name:

 

51.

Middle Name:

   

52.

Last Name:

 

53.

Suffix:

 

54.

Telefax Number:

 

55.

Mobile Number:

 

56.

SSS Number

 

57.

Email Address:

 

Representatives Details

 

58.

First Name:

 

59.

Middle Name:

   

60.

Last Name:

 

61.

Suffix:

 

62.

Telefax Number:

 

63.

Mobile Number:

 

64.

SSS Number

 

65.

Email Address:

 

OWNER’S Signature over Printed Name

Date

 

For DTI/SEC-PBR Kiosk Use Only

   

Fee:

Rec’d by:

TRN/ PBN

Date Registered

BN Certificate No.

Office

OR Number:

Date Paid:

BIR Tax Identification No.

SSS Employer No.

PhilHealth Employer No.

 

PAG-IBIG Employer No.

Page 2 of 2