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ACKNOWLEDGMENT OF NOMINEE STATUS

WITH ASSIGNMENT

I, ___________________________ (hereinafter referred to as the


Nominee), of legal age, Filipino, and with postal address at
_____________________________, hereby acknowledge my status a nominee for
____________________________________ (hereinafter referred to as Principal),
for the purpose of holding _____________( 00,000) Shares of common stock
(hereinafter referred to as the Subject Share) of
________________________________________ (hereinafter referred to as the
Corporation), which Subject Share is presently registered in the books of the
Corporation in the name of the Nominee.

The Nominee hereby unequivocally confirms that the Principal is the


exclusive and absolute owner of the Subject Share. Accordingly, the relationship
between the Principal and the Nominee with respect to the Subject Share is
governed by the following terms and condition:

1. All dividends, whether cash, stock or property, rights and other


privileges accruing on the Subject Share shall be for the account and benefit of
the Principal; and accordingly, the Nominee shall deliver the same to the
Principal or to whomsoever the latter may designate.

2. Directors fees and other amounts received by way of


compensation for services rendered by the Nominee to the Corporation shall be
for the account and benefit of the Principal.

3. The Principal shall save the Nominee free and harmless from any
liability, whether for unpaid subscriptions, taxes or otherwise, that may arise as a
result of the Nominees holding title to the Subject Share for and in behalf of the
Principal.

4. The Nominee hereby assigns, transfer and conveys the Subject


Share to the Principal or his assignee free from all liens and encumbrances, and
hereby undertakes to execute the necessary instrument to transfer title over the
Subject Shares to the Principal or to whomsoever the Principal may designate.

5. This acknowledgment of the status of the Nominee shall be binding


upon the Nominees heirs, executors, and administrators and other successors-in-
interest. The Principal is entitled to custody of the Certificate of Stock over the
Subject Share and the Nominee may only hold or take them for legitimate
purposes known to and cleared with the Principal.

6. The Nominee hereby expressly vests unto the Principal a special


power to sell, convey, transfer or otherwise dispose of the Subject Share at any
time and in a manner it deems appropriate without the need of notice to the
Nominee.

Done this ____th day of ______________ at Angeles City, Philippines.


Principal Nominee

REPUBLIC OF THE PHILIPPINES )


CITY OF ANGELES ) S.S.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public in and for the City of Angeles and the
Province of Pampanga, this ___th day of ________________, personally appeared:

Name Valid ID Date & Place Issue

all known to me and to me known to be the same persons who executed the
foregoing document and they acknowledged to me that the same is their free and
voluntary act and deed.

IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my


notarial seal on the date and at the place first abovewritten.

Doc. No. :
Page No.:
Book No.:
Series of 2016.