ANALYSIS OF CAPITAL STRUCTURE

I.

NAME OF CORPORATION: ___________________________________________

II.

APPLICATION

III.

Verification

Stock Dividend Declaration

A. Retained Earnings per AFS as of __________

Less: Stock Dividend Balance

P_______________
(
)
----------------------------P_______________

B. Authorized Capital Stock

P________________

C. Subscribed Capital Stock, per List/AFS

Less SEC Records:
Pre-incorporation subs/SCS as of latest
increase in capital stock
Stock Dividends declared on:
______________________
______________________

P________________

SEC Resolution/Order dated:

______________________
______________________

( _________________)

(__________________)
---------------------------------

Unaccounted Issuance (if any)

(__________________)

Unissued capital stock

___________________

The abovementioned data are true and correct and that all the requirements for stock dividend
declaration under Section 43 of Corporation Code of the Philippines have been complied with.

_____________________
Treasurer
SUBSCRIBED AND SWORN to before me this __________________ at _________________
affiant exhibited to me his/her Community Tax Certificate No. _______________ issued on
__________________ at ________________ and SSS/TIN/Passport/Drivers Lic. No. _______________
known to me and to me known to be the same person who executed the foregoing instrument.
Doc. No. ______;
Page No. ______;
Book No. _____;
Series of ______.