Local Broker Accreditation Form

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ID PICTURE

LOCAL BROKER ACCREDITATION FORM

PROFILE
Sole Proprietorship Partnership Corporation

Affiliation:

First Name Middle Name Last Name Nickname

Complete Present Address: Zip Code: Country:

Telephone Number: (country code-area code-number) Mobile Number: (country code-area code-number) Fax No. Email Address:

Date of Birth: Place of Birth: Citizenship: Gender:

Passport Number: Issued by: (Name of Govt Agency) Placed Issued: Valid From: Valid To:

Tax Identification Number (TIN): Social Security Number (SSS):

REAL ESTATE BROKER’S LICENSE INFORMATION


Realty Name: Authorized Representative: Designation: Affiliation Date:

License #: Issued by: (Name of Gov’t Agency) Valid From: Valid To: Place Issued:

Business Address: Business Phone Number: Business Fax Number: TIN Number:
(country code-area code-number)

ENDORSED BY: APPROVED BY:

______________________________ _________________________
ASSOCIATE SALES DIRECTOR SALES DIRECTOR - LBN
(SIGNATURE OVER PRINTED NAME) (SIGNATURE OVER PRINTED NAME)
L I S T O F R E Q U I R E M E N T S

Properly filled-out and signed - ACCREDITATION AGREEMENT, BROKERS ACCREDITATION GENERAL POLICIES & BDO ATM Application Form
Photocopy of Real Estate Broker’s License (PRC)
Photocopy of VAT Registration or Proof of TIN or BIR Form 2303
ID pictures with white background in business attire – 2 pcs. each of 2x2 and 1x1 sizes
Additional requirement if to be named under a company: DTI Registration or SEC Registration or Articles of Incorporation

BROKER’S CONFORMITY
I hereby confirm that all information given above are true and correct. I understand that any false information herein may be grounds for SMDC and its
assign to disapprove my application for accreditation.

Further, I agree that my commission will be subject to the applicable withholding taxes.

_____________________________________________________________ _____________
SIGNATURE OF ACCREDITED BROKER OVER PRINTED NAME DATE

SMDC-SRTD-ACCR-CF-0629

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