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PRLD.0018.02 Application for Registration of Real Estate Salesperson
HLURB application form for registration of real estate salesperson
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Housing and Land Use Regulatory Board
Expanded National Capital Region Field Office
6th Floor, Sunnymede IT Center,
1614 Quezon Avenue, South Triangle, Quezon City
APPLICATION FOR REGISTRATION OF REAL ESTATE SALESPERSON
Original ( )
Renewal ( )
Pursuant to Sections 11 and 12 of Presidential Decree No. 957,
as implemented by Board Resolution No. 922, Series of 2014
Name of Applicant: _________________________________________________________________
Civil Status: _______________ Age: _____ Name of Spouse: ______________________________
Office Address:____________________________________________________________________
_________________________________________________________ Tel. No.:________________
Branch Office Address: ______________________________________________________________
_________________________________________________________ Tel. No.: ________________
Residence Address: ________________________________________________________________
_________________________________________________________ Tel. No.:________________
Year Last Registered (for renewal only) __________________________
*Attached herewith are the following:
[ ] Two (2) recent 2 X 2 color photo;
[ ] Photocopy of valid PRC-issued Certificate of Registration and PRC-issued
Professional Identification Card (Originals thereof to be presented upon filing,
for comparison as faithful reproduction);
[ ] Photocopy Letter of Engagement / Employment signed by an HLURB-registered
Dealer or Broker;
[ ] Photocopy of the Bond or Security (Original copy to be presented upon filing,
for comparison as faithful reproduction); and
[ ] Photocopy of the Official Receipt.
Have you ever been convicted of any crime involving a penalty of more than six (6) months
imprisonment? If yes, state the nature:
______________________________________________________________________
______________________________________________________________________
______________________________________________
Printed Name and Signature
______________________, _______________________
Place
Date
________________________________
T.I.N.
*APPLICATION WITH INCOMPLETE REQUIREMENTS WILL NOT BE ACCEPTED FOR PROCESSING
