FRANCHISE APPLICATION FORM
Date: Do you have a Yes
proposed site? No
Applicant
Personal Information
Name of
Applicant:
Last Name First Name Middle Name
Date of
Birth:
MM/DD/YYYY
Place
of Birth:
City Country Zipcode
Residential Address:
(No., Street, Brgy., City, Region, Country, Zipcode
Email
Address: Mobile no.
Telephone no. Civil Status
Citizenship:
Is this your first time applying for Visum Yes
Ventures Franchise? No
Family Background
Single
Mother:
Name of
Last Name First Name Middle Name
Date of
Birth: Business (if any)
MM/DD/YYYY
Occupation:
Family Background
Married:
Name
of Spouse:
Last Name First Name Middle Name
Birth:
Date of Business (if any)
MM/DD/YYYY
Occupation:
Name of Children Date of Birth
Do you have a family member with franchise from Are you related by blood or marriage to any Visum
any
Visum Ventures brands? Ventures employee, Franchisee, or Managing
Director?
Yes
Have you ever been charged of anything other than minor traffic violations?
Has any judgment ever been entered against you or to your company or to your Yes
employer where you were one of the litigants? No
Are
you involved in pending litigation? Yes
Yes
Have you ever declared personal bankruptcy?
No
answered, “Yes” to any of the above, please give details and inclusive details
If you
Educational Background/ Socio-Civic
Activities/ Trainings or Seminars Attended
Educational Background Name of School School Address
*Begin with the most recent year
Inclusive Dates Degree Completed Awards or Citations
*Begin with the most recent year
Title of Trainings/Seminars Attended Conducted By Date (MM/DD/YYYY)
*Begin with the most recent year
Business Experience
*List only Top 3 businesses
Business 1
Present Business Name:
Business
Address:
(No., Street, Brgy., City, Region, Country, Zipcode
Position:
Telephone no. Years in Business:
Business 2
Present Business Name:
Business Address:
(No., Street, Brgy., City, Region, Country, Zipcode
Position:
Telephone no. Years in Business:
Business
3
Present Business Name:
Business Address:
(No., Street, Brgy., City, Region, Country, Zipcode
Position:
Telephone no. Years in Business:
Previous Work Experience
Type of Date Employed
Name of Company Position Address Responsibilities
Business (MM/DD/YYYY)
Personal Financial Background
Salary/Wages: Bonus Commissions:
*Kindly prepare a summary of your business portfolio indicating the contributor’s (from highest to lowest) to your personal/commercial revenues,
and an audited financial and bank statements (for the past six (6) months from all your bank accounts) and submit these.
Reference
Bank / Credit: Name Position Name Position
Applied Franchise Area
Site Address:
(No., Street, Brgy., City, Region, Country, Zipcode
Lot Area (in sqm): Description (if yes:)
property have a building structure?
Does the
Yes No
Total Floor Area (in sqm): Facilities Available:
(check all that apply):
Ground Floor Area (in sqm):
Second Floor Area (in sqm): Water
Frontage
(in sqm): Electricity
Lessor:
Telephone
Monthly Rent:
Security Deposit:
Lease Period:
Advanced Rent:
Other Conditions:
Kindly upload the following documents related to the site:
- Picture of Proposed Site - Lot Plan/ Building Floor Plan
- Detailed Vicinity Map - Signed Nondisclosure Agreement
Parking (No. of slots):
Others:
Compliance with the Data Privacy Act. (i) To the extent that the Franchisor is processing
any Personal Information (including Sensitive Personal Information) of the Applicant in
connection with the implementation of this application and/or the ensuing Franchise
Agreement, such processing shall be performed by Franchisor in accordance with its standards
and requirements as provided in its Data Policy and applicable industry standards on data
protection. Franchisor agrees to comply with all applicable privacy and data protection laws
with regard to the performance or implementation of this document. Any questions or
concerns concerning Franchisor’s Data Privacy Policy may be directed to : Office of the Data
Protection Officer, Visum Ventures Inc. with e-mail address at : franchise@koomi.ph.
(ii) Applicant hereby consents to the processing of Personal Information (including
Sensitive Personal Information) by Franchisor and its authorized agents to facilitate and
implement this Application and/or the ensuing Franchise Agreement.
(iii) For the purposes of this application and/or the ensuing Franchise Agreement, the
terms, “processing”, “Personal Information”, and “Sensitive Personal Information” shall have
the same meaning and interpretation as set out in the Philippine Data Privacy Act of 2012
(Republic Act No. 10173)
CERTIFICATION
I hereby authorize Visum Ventures Inc. to verify and investigate the undersigned from
whatever sources deemed appropriate and in accordance with law.
I fully understand that any false, inaccurate or incorrect information contained herein
shall be considered sufficient ground for rejection of my franchise application and/or breach of
my undertakings, warranties and representations that will cause the termination of any contract
or agreement that may hereafter be executed between Visum Ventures Inc.
Signature over Printed Name
Date
