The Generics Pharmacy Franchising Corp.

TGP Bldg., Edison cor Cul De Sac St., Km. 14 West Service Road
Leviste Homes, Paranaque City 1700
FAX to: 821-1111 loc. 602 TEL: 821-1111 loc. 402
E-mail: comments@tgp.com.ph
www.tgp.com.ph
__________________________________
__________________

FRANCHISE PREQUALIFICATIONFORM
The purpose of this form is for you to provide TheGenerics Pharmacy Franchising Corporation (“Franchisor”) general information to
help evaluate your qualifications for a The Generics Pharmacy franchise.This is not an application. If you qualify and a mutual
interest develops, the Franchisor will request for additional information at that time. This form should be completed by EACH
proposed partner.Please print or type your answers. You may attach additional pages if necessary to provide complete answers.
Please answer all questions.

Date of Application:______________ Reference No.:_____________________

Personal Data
Last Name First Name Middle Name T.I.N. SSS Number

Birthdate Age Tel. No. Mobile Fax No. E-mail Address

Educational Background
Education Level Course / School Year Graduated
Elementary
High School
College
Post Graduate

Current Address/Zip Code Years of Residence

Permanent Address Years of Residence

Residence Verification ___ Owned ___ Mortgaged (monthly amortization)

___ Rented (monthly rental) ___ Used for free ___ Living with Relatives

Single _____ Married _____ Widowed _____ Separated _____

Employment History:
Current Employer Previous Employer
Company
Address
Last Position Held
Years Of Employment
Salary
Full Name of Spouse Occupation

If Employed:
Company Position

Years of employment __________ Salary _______________

If self-employed: Industry _______________________________ Years Operational _____

___ Owned ___ Part – owner ___ Incorporator

Name Age Occupation Company / school

Father
Mother
Spouse
Siblings
 Applicant’s Franchise Plan
I am interested in THE GENERICS PHARMACYfranchise because:
1) ______________________________________________________________________________________
2) ______________________________________________________________________________________
3) ______________________________________________________________________________________

The type of store that I plan to operate is:

FORMAT SIZE OF SPACE DESIRED OR PROPOSED SITE
SOLO OR EXPRESS (15-20sq. mtrs.minimum) ________________________________________________
TANDEM OR IN-STORE (over 20 sq. mtrs. space) ________________________________________________

Would you consider other area?  NO YES – What Area/s?

Will the franchise be owned and operated by yourself or a group?

I plan to operate the franchise business as:
 an individual  active: will be directly involved in management/operation
 with partners  passive: will be behind the scenes

If with partners, state the name of all your partners, or incorporators if under a corporation:

Amount of capital available for this business:

Are you considering other franchise business?

If yes, what are those?

As a potential franchisee, what are your:
Strengths

Weaknesses

How much monthly income do you expect from TGP?

THIS IS NOT A CONTRACT AND SUPPLYING OR COMPLETING THIS FORM INCURS NO OBLIGATION ON EITHER PARTY.

Business or Professional Experience

Will TGP be your only source of income? _____ YES _____ NO
If No, what are those?
Name of Company:
Address:
Position/Title/Duties

Percentage of Ownership/Capitalization

Dates of Business Establishment

How much monthly income do you get from these businesses? ______________
Status of Business OR Employment: Operational/Active [ ] Closed/Inactive [ ]
If closed or inactive, state reasons why:

* PLS. ATTACH YOUR RESUME FOR ADDITIONAL INFORMATION * RESUME ATTACHED [ ]

Physical Condition
General Physical Condition Date of Last Physical Exam

Attending Physician

List Any Physical Impairments or Chronic Illnesses

Which May Preclude Certain Types of Activities

Please explain

Confidential Financial Statements

ASSETS
Cash on Hand (unrestricted in banks)

Bank Accounts

Life Insurance
Stocks and Bonds

Real Estate

Automobile/Vehicles

Other Assets, Enumerable:

Do you have existing loans? _____ YES _____ NO

Type of loan ____________________________________ Principal Amount
____________________________
Monthly Amortization ___________________________ Remaining Years to pay
______________________

Income
Year ____________ State None or N/A if Not Applicable

Earned (salary, commissions, fees, etc.) Php________________________

Interests & Dividends Received Php________________________

Rents Received Php________________________

Other Income
_____________________________________ Php________________________

_____________________________________ Php________________________

_____________________________________ Php________________________

_____________________________________ Php________________________

How do you get to know about TGP Franchising:

_____ Trade Exhibit What?_________________ Where? ____________ When? ______________
_____ Print Ads / Release What magazine / newspaper / publication? ________________________
_____ Leafletting Where? _________________________________________________________
_____ Referral By Whom? _______________________________________________________
Others: ______________________________________________________________________________________

Gross Income Php________________________

References
Please list three professional and character references (Name-Address-Phone No.-Fax No.)
1.
2.
3.
Please list three Credit References (Name-Address-Phone No.-Fax No)
1.
2.
3.
Bank References (Name-Address-Checking Account/Savings Account/Others)
1.
2.
3.
Contingencies
Do you have any contingent liabilities? _____________ Are any of your assets pledged? _________
Have you ever taken bankruptcy? _____________
Are you defendant in any law suits or legal action?____________
THIS IS NOT A CONTRACT AND SUPPLYING OR COMPLETING THIS FORM INCURS NO OBLIGATION ON EITHER PARTY.

In submitting the foregoing statement the undersigned guarantees its accuracy with the intent that it be relied upon in
granting a franchise and extending credit to the undersigned and warrants that he/she has not knowingly withheld any information
that might affect his/her credit risk, and the undersigned expressly agrees to notifyTHEGENERICS PHARMACY
FRANCHISINGCORPORATION (THE GENERICS PHARMACY) immediately in writing of any material change in his/her
financial condition whether application for further credit is made or not and in the absence of such written notice, it is expressly
agreed that THEGENERICS PHARMACY FRANCHISING CORPORATION (THE GENERICS PHARMACY)in granting a
franchise or credit may rely on this statement as having the same force and effect as if delivered upon the date additional credit is
requested or existing credit is extended or continued.
The undersigned certifies that each part of the application and financial statements hereof and the information inserted
herein has been carefully read and is true and correct.

Date:________________ Signed:_______________________________________
Signature over Printed name

This portion to be completed by authorized TGPFC officersonly

Remarks
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Evaluated by: Signature: Date:
The Generics Pharmacy Franchising Corp.
TGP Bldg., Edison cor. Cul De Sac St., Km. 14, West Service Road,
Leviste Homes, Paranaque City
FAX to: 821-1111 loc. 602 TEL: 821-1111 loc. 402
E-mail: comments@tgp.com.ph

HOME SKETCH

Home address: _____________________________________________________________

__________________________________________________________________________
 LETTER OF INTENT

FRANCHISING DEPARTMENT
The Generics Pharmacy

I wish to formalize my keen intention in pursuing a Franchise Application with The Generics Pharmacy for
additional franchise and intend to set up a branch in:

_________________________________________________________________________

_________________________________________________________________________
Attached is the map sketch, details and pictures of the proposed location for your reference.
(Please indicate the boundary notation if it’s near a city boundary)

I also intend to set up a branch in my other preferred areas:

2nd choice: ____________________________________________

3rd choice: ____________________________________________
4th choice: ____________________________________________

Thank you very much and looking forward to having a wonderful partnership with you.

Sincerely yours,

______________________________________ ________________________________________
FRANCHISEE (Signature over Printed Name) BUSINESS NAME ( DTI / SEC )

OTHER DOCUMENTS REQUIRED:

1. PROPOSED LOCATION FORMS
2. FRANCHISE INFORMATION SHEET
3. PROOF OF BILLING
 PROPOSED LOCATION INFORMATION SHEET

Date Submitted: ___________________

LOCATION ADDRESS:
_____________________________________________________________
_____________________________________________________________

BASIC LEASE TERMS AND CONDITIONS

SIZE RENT
ADVANCE RENTAL RENTAL DEPOSIT
LEASE TERM RENEWAL
ESCALATION FRONTAGE
OTHERS

KEY POTENTIAL INDICATORS:

DRUGSTORE MALLS / COMMERCIAL ESTABLISHMENTS
JEEPNEY/TRICYCLE/ BUS STOP SUPERMARKETS / PUBLIC MARKETS
RESIDENTIALS ( villages / subdivisions ) SCHOOLS / COLLEGES
HOSPITALS / CLINICS CHURCH

OTHERS:
STRENGHTS:
NEAREST COMPETITOR: ( w/in 1 km )
NEAREST TGP: ( w/in 1 km )

LESSOR’S DETAILS:
CONTACT PERSON: ____________________________________________________________________
CONTACT NUMBERS: ___________________________________________________________________

Submitted by:
_______________________________________ ___________________________________
FRANCHISE APPLICANT BUSINESS NAME ( DTI / SEC )