Expanded National Capital Region Field Office 6th Floor, Sunnymede IT Center, 1614 Quezon Avenue, South Triangle, Quezon City
APPLICATION FOR REGISTRATION OF REAL ESTATE BROKER
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 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