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ICA-AF Application for Payment of Annual Fees for Investment Company Adviser/Fund Manager
SEC application form for payment of annual fees for investment company adviser/fund manager
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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 •••••
