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Instant Sweepstakes Application Form
PCSO application form for instant sweepstakes
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: REPUBLIC OF THE PHILIPPINES
Office of the President
PHILIPPINE CHARITY SWEEPSTAKES OFFICE
Conservatory Shaw Plaza Building, 605 Shaw Boulevard, Mandaluyong City 1552
www.pcso.gov.ph
----------------------------------------------------------------------------------------------------------------------LETTER OF INTENT
______________________
Date
______________________________________________
Chairman / General Manager
Philippine Charity Sweepstakes Office
Sun Plaza Bldg., 1507 Princeton St. Cor Shaw Blvd, Mandaluyong City
Sir:
Our corporation, ____________________________________________________________________, would like
to signify our interest and intention to apply for authority to distribute nationwide under a non-exclusive all-in contract
involving production, distribution, marketing, advertising and selling instant sweepstakes tickets on a considered sold
basis and at no cost nor risk to PCSO.
Attached herewith are the documents appurtenant to this letter of intent.
Very truly yours,
__________________________________
Signature over Printed Name/Designation
APPLICATION FOR AUTHORITY TO DISTRIBUTE NATIONWIDE THE INSTANT SWEEPSTAKES TICKETS
IDENTIFICATION OF APPLICANT – AUTHORIZED DISTRIBUTOR (AD)
BUSINESS NAME/NAME OF THE CORPORATION:
TAX IDENTIFICATION NUMBER:
DATE REGISTERED WITH THE SEC OR CDA:
COMPLETE PRINCIPAL OFFICE/BUSINESS ADDRESS:
(Building, Number, Street, Barangay, City/Municipality, Province/Region, Zip Code)
CONTACT INFORMATION
Mobile Number/s:
BRANCH OFFICE ADDRESS/ES:
Telephone No./s:
Email Address:
Fax No./s:
Telex No./s:
CONTACT NO./S:
REPUBLIC OF THE PHILIPPINES
Office of the President
PHILIPPINE CHARITY SWEEPSTAKES OFFICE
Conservatory Shaw Plaza Building, 605 Shaw Boulevard, Mandaluyong City 1552
www.pcso.gov.ph
----------------------------------------------------------------------------------------------------------------------APPLICATION FOR AUTHORITY (cont.)
CAPITALIZATION
IDENTIFICATION OF APPLICANT – AUTHORIZED DISTRIBUTOR (AD) (con.)
Authorized:
Paid-Up:
NATURE OF BUSINESS:
TIN NUMBER:
TOTAL NUMBER OF EMPLOYEES:
IDENTIFICATION OF APPLICANT – AUTHORIZED DISTRIBUTOR (AD)
NAME OF AUTHORIZED DISTRIBUTOR
(AD) OFFICERS
POSITION
NATIONALITY
CONTACT NUMBERS/S
* Please use separate sheet of needed
UNDERTAKING
We hereby affirm that all information supplied in the above application are true and correct. We recognize and accept the authority
and power of the Philippine Charity Sweepstakes Office (PCSO) or its duly designated representatives or agents to ascertain the
validity and veracity of any and all information stated herein and in the attached documents supporting this application, and thus
allow PCSO to verify the same and/or secure such other information as may be required, cognizant of the fact that proof of any false
or misleading information supplied, shall constitute grounds for the outright rejection/disapproval of this application.
______________________________________________________
Signature over Printed Name of the Head of Authorized Distributor
NOTE:
Please ensure that all the information required in this application has been
completely and sufficiently provided, and that all the documents required in
the hereto attached checklist have been supplied. Insufficient and incomplete
application shall not be processed.
