Share

Application for Registration of Real Estate Dealer

HLURB application form for registration of real estate dealer

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: PRLD.0016.02

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 DEALER
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 NBI Clearance or Court Clearance (Original copy to be
presented upon filing, for comparison as faithful reproduction);
[ ] 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:
______________________________________________________________________
______________________________________________________________________
I hereby attest that all the foregoing information, data, and submitted documents are true and correct
to the best of my knowledge and have been given freely, voluntarily and without fraudulent or deceitful
intent and purpose whatsoever, and that I have personally read, filled-out, understood and signed the
foregoing application form.
______________________________________________
Printed Name and Signature
______________________, _______________________
Place
Date
_____________________________
T.I.N.
SUBSCRIBED AND SWORN to before me this ______ day of ________________, ______, affiant
exhibiting to me _________________ issued in ___________ on _______________.

NOTARY PUBLIC
Doc. No.
Page No.
Book No.
Series of

:
:
:
:

_______
_______
_______
_______

*APPLICATION WITH INCOMPLETE REQUIREMENTS WILL NOT BE ACCEPTED FOR PROCESSING
 
Page of
Share