COVER SHEET

(Company's Full Name)

(Business Address No. Street City/Town/Province)

(Contact Person) (Company Telephone Number)

Month Day (Form Type) Month Day

(Fiscal Year) (Annual Meeting)

Total No. of Stockholders (Secondary License Type, If Applicable)

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To be accomplished by SEC Personnel concerned

File Number LCU

Document ID Cashier

. . . . . . . . . . . . . . . . . . . . .. .
: :
: STAMPS :
: :
: . . . . . . . . . . . . . . . . . . .. . :
RDS 96-1DS Page 1 of 3
REGISTRATION DATA SHEET
CAPITAL STOCK/INCORPORATORS/DIRECTORS/OFFICERS INFORMATION
(FOR DOMESTIC STOCK CORPORATION ONLY)

SEC NUMBER

FILL UP INSTRUCTIONS: Type or print legibly. Light -shaded boxes are to be filled up by SEC, including the SEC number.
For no-par stockds, leave the authorized capital amount and the par value columns blank.
COMPANY NAME COMPANY TIN

CAPITAL STRUCTURE
AUTHORIZED SUBSCRIBED CAPITAL PAID-UP PAID
PAR NO. OF NO. OF
SHARE CODE SHARE TYPE P/N AMOUNT F/N AMOUNT AMOUNT IN
VALUE SHARES SHARES

PAID -UP CAPITAL CASH PROPERTY OTHERS TOTAL

BY ASSET TYPE
-
INCORPORATORS / STOCKHOLDERS / DIRECTORS / OFFICERS (Use additional sheets if necessary)
NAME TAXPAYER
SHARE NO. OF
(Company Name, if company) IDENTIFICATION BIRTH DATE CODE NATIONALITY BRD INC'R OFR SHARE TYPE SUBSCRIBED CAPITAL PAID-UP CAPITAL
CODE SHARES
(Last Name, First Name, MI, Maiden Surname, if person) NUMBER

SUB-TOTALS - - -
Note: For codes to use in filling up the columns, refer to the last page of this form. Refer also to the back of this page for additional instructions.
RDS 96-1DS Page 3 of 3
REGISTRATION DATA SHEET
CAPITAL STOCK/INCORPORATORS/DIRECTORS/OFFICERS INFORMATION
(FOR DOMESTIC STOCK CORPORATION ONLY)

SEC NUMBER FOR SEC TO PROVIDE: MAINTENANCE NO.: TRANSACTION DATE

FILL UP INSTRUCTIONS: Type or print legibly. Light -shaded boxes are to be filled up by SEC, including the SEC number.
COMPANY NAME

INCORPORATORS / STOCKHOLDERS / DIRECTORS / OFFICERS (Use additional sheets if necessary)

NAME TAXPAYER
(Company Name, if company) IDENTIFICATION CODE NATIONALITY BRD INC'R OFR SHARE CODE SHARE TYPE SUBSCRIBED CAPITAL PAID-UP CAPITAL
(Last Name, First Name, MI, Maiden Surname, if person) NUMBER

NO. OF DIRECTORS: NO. OF STOCKHOLDERS: TOTALS - -

FOREIGN EQUITY BREAKDOWN (Refer to the back of this page for instruction on how to fill-up this section.)
NATIONALITY CODE TOTAL FOREIGN EQUITY
NATIONALITY DESCRIPTION
SUBSCRIBED CAPITAL OF --
INDIVIDUALS
COMPANY (IES)
PAID UP CAPITAL OF --
INDIVIDUALS
COMPANY (IES)
TOTAL PAID-UP CAPITAL
PERCENTAGE OF FOREIGN EQUITY

CERTIFIED CORRECT: POSITION: DATE:

(Signature over printed name)
PROCESSING ATTORNEY: PROCESSING EXAMINER: DATA CONTROL CLERK: DATA ENCODER:
DATE REVIEWED: DATE REVIEWED: DATE REVIEWED: DATE ENCODED:
INSTRUCTIONS FOR FILLING UP THE FOLLOWING COLUMNS:
PAR/NO PAR (P / N) FILIPINO / FOREIGN WITH PAID-IN BOARD (BRD) OFFICER (OFR) INDICATOR -- LEG - LEGAL COUNSEL
VALUE INDICATOR (F/N) OWNED SURPLUS? INDICATOR -- PRE - PRESIDENT AUD - EXTERNAL AUDITOR
P - PAR INDICATOR -- Y - YES C - CHAIRMAN CEO - CHIEF EXECUTIVE OFFICER GOV - GOVERNMENT REPRESENTATIVE
N - NO PAR F - FILIPINO N - NO M - MEMBER CFO - CHIEF FINANCIAL OFFICER OTH - OTHERS
N - NON-FILIPINO / N - NEITHER COO - CHIEF OPERATING OFFICER N - NONE
FOREIGNER COS - CORPORATE SECRETARY
 REGISTRATION DATA SHEET
GENERAL / BUSINESS / COMPANY RELATIONSHIP INFORMATION
(FOR DOMESTIC COMPANIES ONLY)

SEC NUMBER

FILL UP INSTRUCTIONS Type or print legibly. Light-shaded boxes are to be filled up by the SEC. Check appropriate boxes.
FILL UP ONLY THOSE ITEMS FOR WHICH AMENDMENTS OR CHANGES ARE TO BE MADE. Refer to the back of this page for additional instructions.
COMPANY NAME

GENERAL INFORMATION
CHANGE FROM STOCK TO NON
( ) DS - DOMESTIC STOCK ( ) DN - DOMESTIC NON-STOCK ( ) DP - DOMESTIC PARTNERSHIP STOCK (
PRINCIPAL OFFICE ADDRESS

AREA CODE POSTAL CODE TEL. NO. FAX NO.

BUSINESS OFFICE ADDRESS

AREA CODE POSTAL CODE TEL. NO. FAX NO.

BUSINESS INFORMATION
PARTNERSHIP TYPE OF ENTERPRISE [ ] N- NO SPECIAL REGISTRATION [ ] H- FIA HOLDING
[ ] LIMITED [ ] E - FIA EXPORT [ ] R - FIA REPRESENTATIVE OFF
[ ] GENERAL [ ] D - FIA DOMESTIC [ ] S - SUBIC REGISTERED
INDUSTRY CODE TERMS OF EXISTENCE FISCAL YEAR END (MM/DD) ANNUAL MEETING (For Domestic Companies only)

YEARS ( ) F - FIXED (MM/DD) [ ] V - VARIABLE ________________

TYPE OF NON STOCK CORPORATION (Refer to the back of this page for the classification) TOTAL CONTRIBUTION (of domestic non-stock companies) % OF FOREIGN MEMBERSHIP (O

COMPANY RELATIONSHIP - List all companies related to the registrant. (Use additional sheets, if necessary)

RELATIONSHIP TYPE C - DISSOLVED COMPANY ( if due to consolidation) S - PARENT COMPANY (if registrant is a subsidiary)

(RELN TYPE) V - DISSOLVED COMPANY ( if change in company type) A - AFFILIATE (of registrant)
RELN TYPE SEC NUMBER TIN COMPANY NAME

CERTIFIED CORRECT: POSITION: DATE:

(Signature over printed name)
PROCESSING ATTORNEY: PROCESSING EXAMINER: DATA CONTROL CLERK:
DATE REVIEWED: DATE REVIEWED: DATE REVIEWED:
CHANGE FROM STOCK TO NON CHANGE IN PRIMARY
STOCK ) YES PURPOSE ( )X
YES

LDING [ ] F - FINANCIAL INSTITUTION

PRESENTATIVE OFF [ ] Z - EPZA REGISTERED
REGISTERED [ ] B - BOI REGISTERED
Domestic Companies only)

V - VARIABLE ____________________

% OF FOREIGN MEMBERSHIP (Of non-stock companies)

O - OTHERS

COMPANY NAME

DATE:

DATA ENCODER:
DATE ENCODED: