Name of
business : SUBDEALER APPLICATION FORM
GENERAL DETAILS OF BUSINESS CUSTOMER NUMBER:
Sole proprietorship Partnership Corporation
Tax Identification No.: Business Style:
SEC / DTI Registration No. Business registration date :
Business address : Registered address :
City: Region: City: Region:
Telephone no. Fax no. Telephone no. Fax no.
Email Address:
Business Premise Occupancy Status Owned Rented If owned, is it free from encumbrances Yes No
DETAILS OF OWNER / SHAREHOLDERS / PARTNERS
Name TIN Residential address Shareholding (%)
DETAILS OF DIRECTORS / SENIOR MANAGEMENT
Name TIN Residential address Designation
BANK ACCOUNT DETAILS
Bank Name & Branch Contact Person & Number Account Type Account Number
TRADE REFERENCES
Company Name Contact Person Telephone No. Address
AUTHORIZED CHECK SIGNATORIES AUTHORIZED P.O. SIGNATORIES AUTHORIZED GOODS RECEIPT SIGNATORIES
Name Specimen Signature Name Speciment Signature Name Speciment Signature
CONTACT PERSON FOR THE PURPOSE OF: Corporation Partnership Sole Proprietor
SUPPORTING DOCUMENTS
COLLECTION STATUS INQUIRY Req'd Submt'd Req'd Submt'd Req'd Submt'd
Name Contact Number E-mail Address SEC Certificate of Registration
Owner's 2 Valid IDs
Latest GIS
Latest audited FS / ITR
DTI Certificate of Registration
ACCOUNT RECONCILIATION Mayor's Permit
Name Contact Number E-mail Address BIR Certificate of Registration
Organizational Chart
Office Vicinity Map / Shop Photo
DECLARATION BY SOLE PROPRIETOR OR CORPORATION
I / We , TIN acting on behalf of the abovementioned entity* hereby declare that the information above
is true and shall undertake to promptly inform you of any changes to the information supplied.
* the entity named in the "Name of business" section above. Signature over printed name
Designation :
Date :
TO FILLED UP BY RIC ACCOUNTING:
Reviewed By: Approved By:
Finance Head of Division, Aircon Dept Head of Division, Finance President