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28.1-1-AF Application for Payment of Annual Fees for Broker Dealer

SEC application form for payment of annual fees for broker dealer under the implementation rules and Rregulations of the decurities regulation code

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SEC FORM 28.1-1 (BOR)
APPLICATION FOR BRANCH OFFICE REGISTRATION RENEWAL
For the Year
(To be accomplished

--------

in four (4) copies with cover sheet; 3 copies for SEC & 1 receiving copy for the applicant)

Name of Broker Dealer:

Certificate of Registration No.

..

TIN#:

Location of Branch Office:

No. of Salesperson:

Street:
City:
Branch Manager:

Tel #
Fax#
TIN #

Salesperson/s

Certificate of Registration No.

(1)
(2)
'.

(3)
(4)
Contact Person:

The above-named Broker Dealer hereby makes the application for the renewal of its registration of a branch
office located at the address shown above and hereby certifies that the information contained in its most
recent filing of SEC Form 28.1-1 (BaR) is true, correct, accurate and complete.

Printed Name/Signature/Designation

of Authorized Signatory

Reviewed By: .

Signature of Associated Person

Date
'.0

•• 0.0

••••

'0'

••••••

'0'

.0 ••

0 •• 0 •• 0 •• 0 •• 0 •••••

0. :-:"

.0 •••••

Subscribed and sworn to before me this __
valid identity card

0 •••••••

'.'~"_.~~~.~."."

day of
issued at

.0 •••

0 •• 0 "'_'.'~.~"._'_~_~~'!'.'''.~~'''''O

1.

_
_
_
_

Payment of renewal fee - PhP5.050.00

0 •• 0 •• 0 •• 0 •• 0 •• 0. _0 •••

201_. exhibited to me his/her
on
_

Notary Public
Doc No.
Page No.
Book No.
Series

.0 •••••
 
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