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FLYING V RETAIL NETWORK CORPORATION

CO-VENTURE ASSOCIATE PROGRAM

APPLICATION FORM

CONFIDENTIAL

Name of Applicant

Date of Application

Location of Gas Station

This form will help us in evaluating your application as a potential co-venture associate. Please answer
all questions completely and accurately.

www.flyingv.com.ph
 Attach 2x2 pic

PERSONAL INFORMATION
Last Name Given Name Middle Name Gender
F M
Birthplace Citizenship
Age Birthdate (mm/dd/yyyy) Civil Status  Single  Widowed
Height Weight
_____ / _____ / _____ Married  Separated

No. of Dependents Mother's Maiden Name E-mail Address FB / Social Media Account

Skype ID
Home Telephone No. Mobile No. Tax Identification No. SSS / GSIS No.

Complete Present Address Zip Code Lenght of Stay

______ Years ______ Months
Residence Type If residence type is rented, mortgage, living with parents / relatives
 Owned  Rented Monthly Amortization / Rental Landlord / Mortgagor / Contact Person
 Mortgaged  Living with parents / relatives Used Free?  Y  N PHP
Complete Permanent Address Zip Code Educational Status

 High School  College Graduate

Complete Provincial Address Zip Code  Vocational  Post Graduate

 College Level O Masteral O Doctoral

BUSINESS/EMPLOYMENT INFORMATION
Business Name/Employer's Name Nature of Business Rank / Position Title

Business Address/ Employer's Address Company Website Length of Operation

______ Years ______ Months

No. of Branches Location/s No. of Warehouse Location/s

DTI Registration No. Expiration Date Office Mobile No. Office Landline & Fax No. Office Email Address

Type of Products / Services Product's Brand Name No. of Equipments Type of Equipments

Sales Volume Weekly basis/salary Monthly basis/salary Estimated Gross Margin/Month Type of Customer
PHP ______________ PHP ___________ Retail  Wholesale
TRADE REFERENCES
Major Customers Contact Person / Position Contact No.

Major Suppliers Contact Person / Position Contact No.

Person to Contact in case of emergency
Contacts Relation
Address

Are you related or by affinity to an employee of Flying V, TWA, Yes If yes, who?
FVRNC or any RFV Allianz affiliate?
Department and
No
Position

SPOUSE'S INFORMATION & EMPLOYMENT

Last Name Given Name Middle Name Age

Birthdate (mm/dd/yyyy) Birthplace Mobile No. Personal E-mail Address

____ / ____ / ________
Name of Employer Nature of Business Rank / Position Title

Employer Address Company Website Employment Tenure

______ Years ______ Months
Estimated Net Monthly
Office Landline No. Office Fax No. Office E-mail Address
Income

FAMILY BACKGROUND
Name Age Occupation Complete Address Contacts/Mobile No.

Children (eldest to youngest)

Father
Mother
Siblings (eldest to youngest)

Relatives living with the family

Educational Attainment
Degree attained/ Honors/
Education Name of School School Address Inclusive Year attended
Scholarships

Post Graduate

College/ Vocational

High School

Elemenetary

Employment / Business Experience (start from the most recent)

Inclusive Duties and Monthly
Company/Employer Address Position Reason for leaving
Dates Responsibilities Salary
Professional License/s held
Date Expiration
Issued License
Attained Date Issued/Approved by:

Note: Please attach scanned copy of Professional License/s held.

For Declared Identification

ID ID Number Date Issued (DD/MM/YY)

Social Security System (SSS)/ Government Service Insurance

System(GSIS)

Tax Identification Number (TIN)

Driver’s License

Passport

Unified ID System

Other ID available

Note: Please attach scanned copy of at least 3

governmental IDs, (SSS, Passport, Driver's License)
preferably ID’s with picture

Social activities

List your sports and recreational activities:__________________________________________________

_____________________________________________________________________________________

List all civic, social, business organization or clubs you are an active member of:____________________
_____________________________________________________________________________________

What type of relationship do you have with your family? How does this affect your outlook in life?
SUMMARY OF ASSETS & LIABILITIES
CASH IN BANKS
Date
Deposit Type Bank/Branch Account Number Balance Annex
Opened

 Peso Checking Account


 Peso Savings Account


 30-day Peso Time Deposit


 Dollar Savings Account


 Others, pls specify

TOTAL

INVESTMENTS
Account/Certificate Date
Investment Type Bank/Branch Balance Annex
Number Opened

 Long-term Peso Time Deposit


 Long Term Dollar Time Deposit

Date
Investment Type Issuer/Type (Preferred or Common) Certificate Number Par Value Annex
Acquired

 Bonds


 Stocks


 Others, please specify

TOTAL
 REAL ESTATE PROPERTY
TCT No. Location Lot Area Floor Estimated Value If Mortgaged, Mortgagor Remaining Annex
Area amount of Monthly Balance
Amortization?

TOTAL

MOTOR VEHICLE
If Mortgaged, Mortgagor Remaining Balance Annex
Year Plate Estimated amount of
Type of Motor Vehicle
Model Number Value Monthly
Amortization?

TOTAL

DETAILS OF OTHER ASSETS

Business Name and Address /Type of Business Year Established Annual Net Worth Annex

TOTAL

TOTAL ASSETS
 LIABILITIES (LOANS)
Type of Loan Bank/Financial Institution Monthly Amortization Outstanding Balance Annex

 Car Loan


 Housing Loan


 Business Loan


 Personal Loan


 Salary Loan

TOTAL

CREDIT CARD/S
Credit Card Company Card Number Member Since Expiry Date Outstanding Balance Annex

TOTAL

TOTAL LIABILITIES

NET WORTH
CASH FLOW SUMMARY Monthly Annualy REMARKS
Cash Inflow GROSS NET GROSS NET
Income from Salary
Spouse's Salaray
Business 1
Business 2
Business 3

Other Inflow

TOTAL INFLOW

Cash
Outflow
Expenses
UTILITIES
Electricity
Monthly Dues
Water
EDUCATION
Education (1st child)
Education (2nd child)

HOME EXPENSE
Househelp
Groceries

OTHERS
Medical Expenses
Gasoline
Cable
Internet
Cellphone
Others: Identify

Amortization
Home Amortization
Car Amortization

TOTAL OUTFLOW

NET CASH
Personal References
Name Address Business/ Occupation Contact no.

Professional References
Name Address Business/ Occupation Contact no.

Sketch of House (from house to the station)

Annexes
Picture of Home
Picture of Business
Picture (2x2) of Applicant and Spouse
 Scanned copy, at least 2 valid IDs (SSS, Passport, Driver's License,Voter's ID, etc.)
NBI

Health

Do you have any physical handicaps or special precautions and worries about health that would be
shown by a medical examination? (For example: hearing, eyesight, foot ailments, rupture, allergies, lung
or heart condition, stomach condition, headaches, arthritis, sinus, asthma, affected by fumes or cold.)

Yes No If yes, explain

Have you had any illness during the last five years that required the services of the physician?

Yes No If yes, explain

Declaration

I hereby certify that the information given by me is true and correct to the best of my knowledge and
that any material misrepresentation or falsity may be grounds for termination of my
contract/agreement with Flying V. I hereby authorize Flying V to inquire about and investigate all the
declared information from whatever sources Flying V may consider appropriate and to disclose any
information herein provided to any person or entity. For this purpose, I agree to indemnify and hold
Flying V free and harmless from any and all claims, liabilities, damages, suits or causes of action of
whatever nature, now or hereafter arising from or in connection with the foregoing authorization.

__________________________________ _____________________
Signature of applicant over printed name Date