HQP-PFF-106

(V04, 01/2019)
Pag- NUMBER

2 0 5 3 7 7 1 1 0 0 0 0

INSTRUCTIONS REQUIREMENTS
1. This form shall be accomplished in one (1) copy). 1. Change/correction of Employer/Business Name 2. Change of Legal Personality 3. Additional/Change of Authorized
2. Accomplish the applicable portions to be and/or Address A. Single Proprietorship to Corporation Signatory/ies
changed/corrected only. A. For Single Proprietorship SEC Certificate A. For Single Proprietorship
3. Type or print all entries in BLOCK/CAPITAL Amended DTI Certificate Articles of Incorporation Specimen Signature Form (SSF)
LETTERS. Certificate of Cancellation as Single DTI Certificate or Business/
4. Submit duly accomplished form together with B. For Partnership/Corporation Proprietorship
required supporting documents to any Pag-IBIG Amended SEC Certificate B. Partnership to Corporation B. For Partnership/Corporation
Branch nearest you. Amended Articles of Partnership/Incorporation Articles of Incorporation Specimen Signature Form (SSF)
Note: Please submit photocopy of the documents C. For Cooperative/Trade Association Deed of Dissolution of Partnership Board Resolution
depending on the information to be changed. The CDA Certificate (For Cooperative)
Certified True Copy of the said documents shall be Amended SEC Certificate of Incorporation (For
presented for authentication. Trade Association)

CHECK APPROPRIATE BOX ONLY

1. CHANGE/CORRECTION OF EMPLOYER/BUSINESS NAME 3. CHANGE OF LEGAL PERSONALITY 5. OTHERS (PLEASE SPECIFY)
2. CHANGE/CORRECTION OF ADDRESS/CONTACT DETAILS 4. CHANGE OF AUTHORIZED SIGNATORY/IES
____________________________________
EMPLOYER/BUSINESS NAME TAXPAYER IDENTIFICATION NUMBER (TIN)
ONEXPRESS CARRIER INC 008-396-485-000
1. CHANGE/CORRECTION OF EMPLOYER/BUSINESS NAME
FROM TO
N/A N/A
2. (Please accomplish portions to be changed only)
Unit/Room No., Floor Building Name COUNTRY+AREA CODE TELEPHONE NUMBER
Business (Direct Line)
632 8932-7875
Lot No. Block No. Phase No. House No. Street Name
Business (Fax)
89
Subdivision Barangay Business (Trunkline) Local
CALMAY
Municipality/City Province ZIP Code Email Address
[email protected]
CALMAY PANGASINAN 2437
3. CHANGE OF LEGAL PERSONALITY
FROM TO
N/A N/A
4. CHANGE OF AUTHORIZED SIGNATORY/IES (Use separate sheet if necessary)
FROM TO

JOSE BENEDICT E. LOPENA

___________________________________ PRESIDENT
_____________________________
JOSE BENEDICT E. LOPENA
___________________________________
PRESIDENT
__________________________
Name Official Designation Name Official Designation
CAROLINA E. LOPENA CHAIRMAN CAROLINA E. LOPENA CHAIRMAN
___________________________________ _____________________________ ___________________________________ __________________________
Name Official Designation Name Official Designation
AARON DOYLE E. LOPENA VP - FINANCE AARON DOYLE E. LOPENA VP - FINANCE
___________________________________ _____________________________ ___________________________________ ___________________________
Name Official Designation Name Official Designation
5. OTHERS (Please specify)
FROM TO
N/A N/A
CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION GIVEN AND ALL STATEMENTS MADE HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND
BELIEF. I FURTHER CERTIFY THAT MY SIGANTURE APPEARING HEREIN IS GENUINE AND AUTHENTIC.

JOSE BENEDICT E. LOPENA

____________________________________________________ __________________________________ _________________________
HEAD OF OFFICE OR AUTHORIZED SIGNATORY/IES DESIGNATION/POSITION DATE
(Signature Over Printed Name)
FOR Pag-IBIG FUND USE ONLY
DOCUMENTS SUBMITTED RECEIVED BY DATE APPROVED BY DATE
DTI/SEC Registration CDA Certificate
SEC Certificate of Incorporation
Amended Articles of Partnership/
Incorporation/Cooperation Specimen Signature Form (SSF)
Board Resolution Others (Please specify)
__________________________
THIS FORM MAY BE REPRODUCED. NOT FOR SALE.