Client Profile Registration System

CPRS - Importer Profile Information

DATA ITEM INFORMATION

Scanned Photo / Mandatory

Please submit your photo or logo in JPEG Form.

To engage in business of selling, distributing,
marketing at wholesale, insofar as permitted
Nature of Business / Mandatory by law, all kinds of pharmaceutical products
Business Name / Mandatory FHARMALI PHARMACEUTICAL
Accepts the following special characters [. / ' - & ( )] CORPORATION
First Name / Mandatory
Only for clients with business entity "Individual" or "Sole
Proprietorship"
Middle Name / Mandatory
Only for clients with business entity "Individual" or "Sole
Proprietorship"
Last Name / Mandatory
Only for clients with business entity "Individual" or "Sole
Proprietorship"
Country of Citizenship/ Mandatory PHILIPPINES

Address
Address / Mandatory Fort Victoria 23rd Flr. Tower B Unit 8 & 9
Accepts the following special characters [. / , -] Rizal Drive 5th Ave. Cor 23rd Fort Bonifacio
City / Mandatory Taguig
Accepts the following special characters [. / , -]
Zip Code / Mandatory 1634
Country / Mandatory PHILIPPINES
Contact Information
Phone / Mandatory 02 89095827
Minimum must be 7 characters
Alternate Phone / Optional
Minimum must be 7 characters
Mobile Phone/ Optional
Minimum must be 7 characters
Fax / Optional
Minimum must be 10 characters
Email/ Mandatory [email protected]
URL/Website / Optional
Warehouse / Transit Shed Code/ Optional
JO 2-91 Reference Number / Only for clients with Nature of
Business "Government Services Jo 2-91"
Period of Effectivity / Only for clients with Nature of Business
"Government Services Jo 2-91"
Capacity / Only for clients with Nature of Business "Government
Services Jo 2-91"
TIN / Mandatory 752-285-052-000
Social Security Number/ Optional
Passport Number/ Optional
Driver's License / Optional
PRC ID No. / Optional
Primary VASP CCN No. / Mandatory VA0000000434
Secondary VASP CCN No. / Optional

This is to certify that all information in this page are true and correct.
Approved for CPRS registration by: ___________________________________ Page - 1 /4
Authorized Company Officer CPRS Importer Form
 Client Profile Registration System
PEZA-BOI Registration Number (if
applicable)/CARR Code / Optional
This field becomes mandatory when the business entity is set to
"Company", "Corporation" or "Partnership".
SEC Registration Number / Mandatory
This field becomes mandatory when the business entity is set to CS201954924
"Company", "Corporation" or "Partnership".
Amount of Authorized Capital Stock/ Mandatory
This field becomes mandatory when the business entity is set to Php 1,000,000.00
"Company", "Corporation" or "Partnership".
Amount of Paid up Capital/ Mandatory
This field becomes mandatory when the business entity is set to Php 625,000.00
"Company", "Corporation" or "Partnership".

Related domestic & foreign companies

Accepts the following special characters [. / ' -]

Related company 1 / Optional

Related company 2 / Optional
Related company 3 / Optional
Primary Broker / Mandatory
TIN / Mandatory 275-395-095-000
Code / Mandatory BR0000682616
Secondary Broker / Optional
TIN / Mandatory
Code / Mandatory
Plant Addresses/ Mandatory to indicate at least one (1) Plant Address
Address/ Mandatory Fort Victoria 23rd Flr. Tower B Unit 8 & 9
Accepts the following special characters [. / ' -] Rizal Drive 5th Ave. Cor 23rd Fort Bonifacio
City / Mandatory
Taguig City
Accepts the following special characters [. / ' -]
Zip Code / Mandatory 1634
Country / Mandatory PHILIPPINES
Major Stockholders/ Mandatory to indicate at least one (1) Major Stockholder
This field becomes mandatory when the business entity is set to "Company", "Corporation" or "Partnership"
Please put the name of a member of the Board of Directors.

First Name / Mandatory Yeng

Middle Name / Mandatory Tsu
Last Name / Mandatory Hwang
Country of Citizenship/ Mandatory Philippines
TIN / Mandatory 248-402-222-000

Photo / Mandatory
Please submit in JPEG Form.
Signature / Mandatory

Please submit in JPEG Form.

Address
Address / Mandatory Block 2 Lot 1 Scotland St. Ext. Annex 22,
Accepts the following special characters [. / , -] Brgy. Don Bosco
City / Mandatory
Accepts the following special characters [. / , -] Paranaque City
Zip Code/ Mandatory 1711

This is to certify that all information in this page are true and correct.
Approved for CPRS registration by: ___________________________________ Page - 2 /4
Authorized Company Officer CPRS Importer Form
 Client Profile Registration System
Country/ Mandatory Philippines
Phone / Mandatory
Minimum must be 7 characters 02 89095727
Alternate Phone / Optional
Minimum must be 7 characters
Mobile / Optional
Minimum must be 7 characters
Fax / Optional
Minimum must be 10 characters
Email / Mandatory [email protected]
Principal Officers/ Mandatory to indicate at least one (1) Principal Officer
First Name / Mandatory Huang
Middle Name / Mandatory Go
Last Name / Mandatory Tan
Position / Mandatory Finance – Operations Officer
TIN / Mandatory 290-990-776-000
Photo / Mandatory

Please submit in JPEG Form.

Signature / Mandatory

Please submit in JPEG Form.

Address
Address / Mandatory
Accepts the following special characters [. / , -] Unit 3, 24 Hernandez Avenue, Valley 3
City / Mandatory
Accepts the following special characters [. / , -] Paranaque City
Zip Code / Mandatory 1711
Country / Mandatory Philippines
Phone / Mandatory
Minimum must be 7 characters 02 8810 4860
Alternate Phone / Optional
Minimum must be 7 characters
Mobile / Optional
Minimum must be 7 characters
Fax / Optional
Minimum must be 10 characters
Email / Mandatory [email protected]
Responsible Officers/ Mandatory to indicate at least one (1) Responsible Officer
First Name / Mandatory Twinkles
Middle Name / Mandatory Dargani
Last Name/ Mandatory Tan
Position/ Mandatory Admin & Logistics Officer
TIN / Mandatory 237-228-097-000
Area of Responsibility / Mandatory Admin & Logistics Operation
Photo / Mandatory

Please submit in JPEG Form.

Signature / Mandatory
Please submit in JPEG Form.
Address
Address / Mandatory Unit 3, 24 Hernandez Avenue, Valley 3

This is to certify that all information in this page are true and correct.
Approved for CPRS registration by: ___________________________________ Page - 3 /4
Authorized Company Officer CPRS Importer Form
 Client Profile Registration System
Accepts the following special characters [. / , -]
City / Mandatory
Accepts the following special characters [. / , -] Paranaque City
Zip Code / Mandatory 1700
Country / Mandatory Philippines
Phone / Mandatory
Minimum must be 7 characters 02 8211 8756
Alternate Phone / Optional
Minimum must be 7 characters
Mobile / Optional
Minimum must be 7 characters
Fax / Optional
Minimum must be 10 characters
Email/ Mandatory [email protected]
Major Suppliers/ Mandatory to indicate at least one (1) Major Supplier
TIN / Mandatory 000000000000
Name / Mandatory XIAMEN FULLY WIN IMPORT AND EXPORT
Address
Address / Mandatory 2 TOWER C KINGTOP DIGITAL BUILDING
Accepts the following special characters [. / , -] 1819 LULING ROAD SIMING
City / Mandatory XIAMEN
Accepts the following special characters [. / , -]
Zip Code / Mandatory 1819
Country / Mandatory CHINA
Phone / Mandatory
Minimum must be 7 characters +86-714-434-7102
Alternate Phone / Optional
Minimum must be 7 characters
Mobile / Optional
Minimum must be 7 characters
Fax / Optional
Minimum must be 10 characters
Email/ Mandatory [email protected]

Kindly send your duly accomplished form via email at [email protected]. Thank you.
E-KONEK HELPDESK HOTLINE NUMBERS: (02) 4592133/ 1-800-108EKONEK

This is to certify that all information in this page are true and correct.
Approved for CPRS registration by: ___________________________________ Page - 4 /4
Authorized Company Officer CPRS Importer Form
 SECRETARY’S CERTIFICATE

I, Huang Go Tan, of legal age, single, Filipino, with office address at Fort Victoria 23rd Flr. Tower B, Unit 8
& 9 Rizal Drive 5th Ave.Cor 23rd Fort Bonifacio, Taguig City hereby depose and say as follows:

1. That I am the duly elected Corporate Secretary of Fharmali Pharmaceutical Corporation, a

corporation duly organized and existing by virtue of the laws of the Republic of the
Philippines, with principal office and place of business at at Fort Victoria 23rd Flr. Tower B,
Unit 8 & 9 Rizal Drive 5th Ave.Cor 23rd Fort Bonifacio, Taguig City;

2. At a duly constituted meeting of the Board of Directors of the Corporation held on January
11, 2021 at which meeting quorum was present and acted throughout, the following
Resolutions were approved by at least majority of the members;

“RESOLVED, as it is hereby resolved, that Fharmali Pharmaceutical Corporation be authorized as it is

hereby authorized to secure accreditation and registration with the Bureau of Customs;

“RESOLVED FURTHER, that the Corporation be authorized, as it is hereby authorized, to appoint the
following authorized representatives of the Corporation in the negotiations with the BUREAU OF
CUSTOMS or any member thereof;

NAME POSITION SPECIMEN SIGNATURE

1. YENG T. HWANG CORP. PRESIDENT _________________

2. TWINKLES D. TAN ADMIN & LOGISTICS OFFICER _________________

“RESOLVED FURTHERMORE, that the Corporation be authorized, as it is hereby authorized, to appoint

the above-mentioned representatives as Designated Signatories of the Corporation in the import entries
and all pertinent documents which may be necessary under the premises for and in behalf of the
Corporation;

And “RESOLVED FINALLY that the Corporate Secretary is hereby authorized to certify the foregoing
resolutions”

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature and the seal of the Corporation this 22nd day
of March 2021 at Fort Victoria 23rd Flr. Tower B, Unit 8 & 9 Rizal Drive 5th Ave.Cor 23rd Fort Bonifacio,
Taguig City, Philippines.

Huang G. Tan
Corporate Secretary

Subscribed and sworn to before me this _______ day of _____________ at __________, affiant exhibiting
to me his Community Tax Certificate No. _____________ issued on _______________ in ____________
and her SSS No./Passport No. _________________, which will expire on ____________