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COVER SHEET

S.E.C. Registration Number

(Companys Full Name)

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

Contact Person Month Day Fiscal Year Meeting FORM TYPE

Company Telephone No. Month Day Annual

Secondary License Type, If Applicable Dept. Requiring This Doc. Numbers/Section Borrowings Total No. of Stockholders Domestic Foreign Amended Total Amount Articles of

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To be accomplished by SEC Personnel concerned File Number _____________________________ LCU _____________________________ Cashier

Document I.D

STAMPS

Remarks = Pls. Use black ink for scanning purposes

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