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IHU/GSED-AF Application for Payment of Annual Fees for Investment House/Underwriter of Securities/ Government Securities Eligible Dealers

SEC application form for payment of annual fees for investment house/underwriter of securities/ government securities eligible dealers under the omnibus rules and regulations for investment house and universal banks registered as underwriter of securities

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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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