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Broker Application Form
PDIC application form for broker
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: This Form is NOT FOR SALE.
PHILIPPINE DEPOSIT INSURANCE CORPORATION
Rev Jul 2011
1”1/2 x 1”1/2
Photo taken
within the last six
(6) months
APPLICATION FORM
FOR ACCREDITATION OF REAL ESTATE BROKERS
Broker’s Name
Family Name
First Name
Middle Name
No./Street
District/Barangay
City/Municipality
Zip Code
No./Street
District/Barangay
City/Municipality
Zip Code
Home Address
Business Name
Business Address
Real Estate License Number:
Expiry Date
Contact Nos. (Office/Residence)_______________________________ Mobile No. _____________________
Email Address ________________________________________ Fax No. _________________________
Present Organization Affiliation
Present Accreditation with Other Companies:
(Other) real estate companies _______________________________________________________
Banks _______________________________________________________________________________
Government agencies _______________________________________________________________
SPECIALIZATION PROFILE: (Please check)
Number of Years as Realty Broker : ____________
Activities:
Leasing
Selling
Vertical
Horizontal
Location:
Metro Manila
Luzon
Visayas
Mindanao
Property Type:
Condominium
Industrial
Residential
Commercial
ACCESS TO REAL ESTATE INDUSTRY RESOURCES (please specify, if any):
Advertising Medium
:
Marketing Programs
:
Broker Tie Ups/Associations
:
Market Research/Information
:
How would you like your commission to be paid?
Check
Credit to PNB Acct No.________________ Branch ________________________
I hereby certify that all information provided herein are true and correct.
Broker Applicant’s Signature
Date
Checklist of Document for Submission
Certified Photocopy of valid Real Estate Broker’s License
Latest NBI Clearance (issued not more than 6 months)
Two (2) recent “1” ½ x 1” ½ pictures
Certified Photocopy of Certificate of Registration Issued by
PRC
Duly accomplished BIR Form No. 1905 (or latest filed
income tax return)
Notarized Terms & Conditions
Photocopy of any of two of photo-bearing government-issued identification documents such as: passport, driver’s license,
police clearance, other Professional Regulation Commission license, SSS or GSIS or UMID card.
