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Broker Application Form: Personal Profile

This document is a broker application form that collects personal and professional information from applicants. It requests details like name, address, contact information, license and registration details. It also lists the requirements and documents needed for individual brokers and broker groups to apply.

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Anonymous JIHJTWw4Th
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184 views1 page

Broker Application Form: Personal Profile

This document is a broker application form that collects personal and professional information from applicants. It requests details like name, address, contact information, license and registration details. It also lists the requirements and documents needed for individual brokers and broker groups to apply.

Uploaded by

Anonymous JIHJTWw4Th
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BROKER APPLICATION FORM

LOCAL BROKER NETWORK GROUP


ID PICTURE
Application for:

Licensed Broker (new)

Renewal

Others: _______________

PERSONAL PROFILE
FIRST NAME

MIDDLE NAME

FAMILY NAME

FULLNAME:

COMPLETE ADDRESS:
RESIDENCE PHONE NO:

MOBILE NO:

FAX NO:

EMAIL ADDRESS:

DATE OF BIRTH:

PLACE OF BIRTH:

AGE:

NATIONALITY:

CIVIL STATUS:

GENDER:

TAX IDENTIFICATION NO.(TIN #):

SOCIAL SECURITY NO.(SSS#):

___
___
___
___

___ MALE
___ FEMALE

SINGLE
MARRIED
WIDOW / ER
OTHERS

REALTY INFORMATION/ REAL ESTATE BROKERS LICENSE INFORMATION


REALTY NAME :

AUTHORIZED REPRESENTATIVE (LICENSED BROKER):

OFFICE ADDRESS:

ORGANIZATION AFFILIATION:
PRC LICENSE #:

HLURB REG.:

CONTACT #:

EMAIL ADDRESS:

LIST OF AGENTS
NAME OF AGENT

MOBILE #

EMAIL ADDRESS

1.
2.
3.
4.
5.
BROKER COORDINATOR:

DATE OF ACCREDITATION:

LIST OF REQUIREMENTS
INDIVIDUAL BROKERS:

BROKER GROUPS:

___ Broker Application Form


___ Accreditation Agreement
___ Photocopy of PRC License
___ Certificate of Registration
___ VAT Registration/ Proof of TIN
___ Sworn Statement (NON-VAT Reg)/ Photocopy of Official Receipt
___ 1 pc 1x1 or 2x2 picture

___Broker Application Form


___ Accreditation Agreement
___ Photocopy of PRC License
___ Certificate of Registration
___ DTI/SEC Registration
___ Articles of Incorporation & By-laws
___ Secretarys Certificate/ Board Resolution
___ VAT Registration/ Proof of TIN/ Photocopy of Official Receipt
___ 1 pc 1x1 or 2x2 picture

I hereby certify that the above information is true and correct to the best of my knowledge and that TORRE LORENZO
DEVELOPMENT CORPORATION is authorized to obtain such information as it may require for the purpose of evaluating my
application.
____________________________________
Broker Signature over Printed Name
Received by:

Noted by:

_________________________________________
Broker Coordinator (Signature over Printed Name)

______________________________________________
Broker Network Manager (Signature over Printed Name)

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