2019-07-26
The Securities and Exchange Commission issued Memorandum Circular No. 15, Series of 2019, amending the General Information Sheet to mandate the disclosure of beneficial ownership information for stock and non-stock corporations. The revised forms require filers to identify natural persons who ultimately own or control the entity through specific categories such as direct ownership, nominee arrangements, or executive control. Corporations must submit the completed GIS within thirty calendar days of their annual meeting and file amended reports within seven days of any relevant changes to maintain compliance with regulatory standards.
GENERAL INSTRUCTIONS: 1. 2. 3. 4. 5. 6. 7. BUSINESS/TRADE NAME: WEBSITE/URL ADDRESS: INDUSTRY CLASSIFICATION: FISCAL YEAR END: ACTUAL DATE OF ANNUAL MEETING: GEOGRAPHICAL CODE: SEC ACCREDITATION NUMBER (if applicable): COMPLETE BUSINESS ADDRESS: PRIMARY PURPOSE/ACTIVITY/INDUSTRY PRESENTLY ENGAGED IN: THE SEC SHOULD BE TIMELY APPRISED OF RELEVANT CHANGES IN THE SUBMITTED INFORMATION AS THEY ARISE. FOR CHANGES RESULTING FROM ACTIONS THAT AROSE BETWEEN THE ANNUAL MEETINGS, THE CORPORATION SHALL SUBMIT AMENDED GIS CONTAINING THE NEW INFORMATION TOGETHER WITH A COVER LETTER SIGNED THE CORPORATE SECRETARY OF THE CORPORATION. THE AMENDED GIS AND COVER LETTER SHALL BE SUBMITTED WITHIN SEVEN (7) DAYS AFTER SUCH CHANGE OCCURED OR BECAME EFFECTIVE. SUBMIT FOUR (4) COPIES OF THE GIS TO THE RECEIVING SECTION AT THE SEC MAIN OFFICE, OR TO SEC SATELLITE OFFICES OR EXTENSION OFFICES. ALL COPIES SHALL UNIFORMLY BE ON A4 OR LETTER-SIZED PAPER. THE PAGES OF ALL COPIES SHALL USE ONLY ONE SIDE CORPORATE TAX IDENTIFICATION NUMBER (TIN) DATE OF ANNUAL MEETING PER BY-LAWS: THIS GIS MAY BE USED AS EVIDENCE AGAINST THE CORPORATION AND ITS RESPONSIBLE DIRECTORS/OFFICERS FOR ANY VIOLATION OF EXISTING LAWS, RULES AND REGULATIONS NOTE: USE ADDITIONAL SHEET IF NECESSARY TELEPHONE NUMBER(S): ONLY THE GIS ACCOMPLISHED IN ACCORDANCE WITH THESE INSTRUCTIONS SHALL BE CONSIDERED AS HAVING BEEN FILED. PARENT COMPANY NAME OF EXTERNAL AUDITOR & ITS SIGNING PARTNER: FAX NUMBER: SUBSIDIARY/AFFILIATE SEC REGISTRATION NO. GENERAL INFORMATION SHEET (GIS) FOR USER CORPORATION: THIS GIS SHOULD BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE ANNUAL STOCKHOLDERS' MEETING. DO NOT LEAVE ANY ITEM BLANK. WRITE "N.A." IF THE INFORMATION REQUIRED IS NOT APPLICABLE TO THE CORPORATION OR "NONE" IF THE INFORMATION IS NON-EXISTENT. IF THE ANNUAL STOCKHOLDERS' MEETING IS HELD ON A DATE OTHER THAN THAT STATED IN THE BY-LAWS, THE GIS SHALL BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS AFTER THE ELECTION OF THE DIRECTORS, TRUSTEES AND OFFICERS OF THE CORPORATION AT THE ANNUAL MEMBERS' MEETING. STOCK CORPORATION FOR THE YEAR IF NO MEETING IS HELD, THE CORPORATION SHALL SUBMIT THE GIS NOT LATER THAN JANUARY 30 OF THE FOLLOWING YEAR. HOWEVER, SHOULD AN ANNUAL STOCKHOLDERS' MEETING BE HELD THEREAFTER, A NEW GIS SHALL BE SUBMITTED/FILED. THIS GIS SHALL BE ACCOMPLISHED IN ENGLISH AND CERTIFIED AND SWORN TO BY THE CORPORATE SECRETARY OF THE CORPORATION. ================================ PLEASE PRINT LEGIBLY ===================================== CORPORATE NAME: DATE REGISTERED: SEC REGISTRATION NUMBER: ADDRESS ================================ INTERCOMPANY AFFILIATIONS ======================================= E-MAIL ADDRESS: SEC REGISTRATION NO. ADDRESS COMPLETE PRINCIPAL OFFICE ADDRESS: ANNEX "B" GIS_STOCK(v.2019) Page 1
A. 1. a. b. c. d. e. f. g. h. i. j. k. 2. a. b. a. c. b. d. e. f. g. h. c. i. j. 3. a. d. b. c. 7. d. a. e. f. b. g. h. c. i. j. k. d. l. m. 8. n. Describe nature of business: B. Persons who provide any of the following services: Professional Reinsurers Reinsurance Brokers None of the above organization of contributions for the creation, operation or management of companies Securities Salesman Other entities managing Securities or rendering similar services Investment Houses Investment Agents and Consultants Trading Advisors Holding Company Systems Pre-need Companies Common Trust Funds or Issuers and other similar entities Transfer Companies and other similar entities Other entities administering or otherwise dealing in currency, commodities or financial derivatives based there on Entities administering of otherwise dealing in valuable objects management of bank, savings or securities accounts Entities administering or otherwise dealing in cash Substitutes and other similar monetary instruments or property supervised and/or regulated by the Securities and Exchange Commission (SEC) Mutual Funds or Open-end Investment Companies Close-end Investment Companies providing a registered office, business address or accommodation, correspondence or administrative address for a company, a partnership or any other legal person or arrangement acting as a formation agent of juridical persons Company service providers which, as a business, provide any of the following services to third parties: GENERAL INFORMATION SHEET STOCK CORPORATION ================================ PLEASE PRINT LEGIBLY ================================ Please check the appropriate box: Corporate Name: acting as (or arranging for another person to act as) a nominee shareholder for another person All Other Persons and entities supervised and/or regulated by the Insurance Commission (IC) Is the Corporation a covered person under the Anti Money Laundering Act (AMLA), as amended? (Rep. Acts. 9160/9164/10167/10365) acting as (or arranging for another person to act as) a director or corporate secretary of a company, a partner of a partnership, or a similar position in relation to other juridical persons Securities Brokers Insurance Brokers Mutual Benefit Association Securities Dealers Foreign Exchage Dealers Money Changers Remittance Agents Offshore Banking Units Quasi-Banks Trust Entities Non-Stock Savings and Loan Associations Has the Corporation complied with the requirements on Customer Due Diligence (CDD) or Know Your Customer (KYC), record-keeping, and submission of reports under the AMLA, as amended, since the last filing of its GIS? creation, operation or management of juridical persons or arrangements, and buying and selling business entities managing of client money, securities or other assets Banks Pawnshops Insurance Agents 4. Jewelry dealers in precious metals, who, as a business, trade in precious metals 5. Jewelry dealers in precious stones, who, as a business, trade in precious stone 6. Electronic Money Issuers Insurance Companies Financial Institutions which Under Special Laws are subject to Bangko Sentral ng Pilipinas' (BSP) supervision and/or regulation, including their subsidiaries and affiliates. Holding Companies GIS_STOCK(v.2019) Page 2
NUMBER OF SHARES TOTAL TOTAL P F I L I P I N O NO. OF STOCKHOLDERS NUMBER OF SHARES NUMBER OF SHARES IN THE HANDS OF THE PUBLIC ** PAR/STATED VALUE AMOUNT (PhP) % OF OWNERSHIP TOTAL P F O R E I G N (INDICATE BY NATIONALITY) NO. OF STOCKHOLDERS NUMBER OF SHARES NUMBER OF SHARES IN THE HANDS OF THE PUBLIC ** PAR/STATED VALUE AMOUNT (PhP) % OF OWNERSHIP TOTAL P F I L I P I N O NO. OF STOCKHOLDERS NUMBER OF SHARES AMOUNT (PhP) % OF OWNERSHIP TOTAL TOTAL P F O R E I G N (INDICATE BY NATIONALITY) NO. OF STOCKHOLDERS NUMBER OF SHARES AMOUNT (PhP) % OF OWNERSHIP TOTAL TOTAL P TOTAL PAID-UP P TYPE OF SHARES * SUBSCRIBED CAPITAL PAR/STATED VALUE AMOUNT (PhP) (No. of shares X Par/Stated Value) TYPE OF SHARES * NOTE: USE ADDITIONAL SHEET IF NECESSARY ** Other than Directors, Officers, Shareholders owning 10% of outstanding shares.
CORPORATE NAME: NATIONALITY INC'R BOARD GENDER STOCK HOLDER OFFICER EXEC. COMM. TAX IDENTIFICATION NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. FOR SEX COLUMN, PUT "F" FOR FEMALE, "M" FOR MALE. FOR OFFICER COLUMN, INDICATE PARTICULAR POSITION IF AN OFFICER, FROM VP UP INCLUDING THE POSITION OF THE TREASURER, SECRETARY, COMPLIANCE OFFICER AND/OR ASSOCIATED PERSON. FOR EXECUTIVE COMMITTEE, INDICATE "C" IF MEMBER OF THE COMPENSATION COMMITTEE; "A" FOR AUDIT COMMITTEE; "N" FOR NOMINATION AND ELECTION COMMITTEE. ADDITIONALLY WRITE "C" AFTER SLASH IF CHAIRMAN AND "M" IF MEMBER. FOR INC'R COLUMN, PUT "Y" IF AN INCORPORATOR, "N" IF NOT. FOR STOCKHOLDER COLUMN, PUT "Y" IF A STOCKHOLDER, "N" IF NOT. GENERAL INFORMATION SHEET INSTRUCTION: FOR BOARD COLUMN, PUT "C" FOR CHAIRMAN, "M" FOR MEMBER, "I" FOR INDEPENDENT DIRECTOR. STOCK CORPORATION ================================ PLEASE PRINT LEGIBLY ================================ D I R E C T O R S / O F F I C E R S NAME/CURRENT RESIDENTIAL ADDRESS
GIS_STOCK (v.2019) Page 4
TYPE NUMBER AMOUNT (PhP) % OF OWNERSHIP 1 TOTAL 2. TOTAL 3. TOTAL 4. TOTAL 5. TOTAL 6. TOTAL 7. TOTAL 0.00% Note: For PDTC Nominee included in the list, please indicate further the beneficial owners owning more than 5% of any class of the company's voting securities. Attach separate sheet, if necessary. INSTRUCTION: SPECIFY THE TOP 20 STOCKHOLDERS AND INDICATE THE REST AS OTHERS TOTAL AMOUNT OF SUBSCRIBED CAPITAL TOTAL AMOUNT OF PAID-UP CAPITAL 0.00 SHARES SUBSCRIBED NAME, NATIONALITY AND CURRENT RESIDENTIAL ADDRESS AMOUNT PAID (PhP) TAX IDENTIFICATION NUMBER GENERAL INFORMATION SHEET STOCK CORPORATION ================================ PLEASE PRINT LEGIBLY ================================ TOTAL NUMBER OF STOCKHOLDERS: STOCKHOLDER'S INFORMATION CORPORATE NAME: NO. OF STOCKHOLDERS WITH 100 OR MORE SHARES EACH: TOTAL ASSETS BASED ON LATEST AUDITED FINANCIAL STATEMENTS: GIS_STOCK (v.2019) Page 5
TYPE NUMBER AMOUNT (PhP) % OF OWNERSHIP 8. TOTAL 9. TOTAL 10. TOTAL 11. TOTAL 12. TOTAL 13. TOTAL 14. TOTAL 0.00% STOCKHOLDER'S INFORMATION NAME, NATIONALITY AND CURRENT RESIDENTIAL ADDRESS GENERAL INFORMATION SHEET STOCK CORPORATION CORPORATE NAME: TOTAL NUMBER OF STOCKHOLDERS: TOTAL ASSETS BASED ON LATEST AUDITED FS: AMOUNT PAID (PhP) ==================================== PLEASE PRINT LEGIBLY ================================== TAX IDENTIFCATION NUMBER NO. OF STOCKHOLDERS WITH 100 OR MORE SHARES EACH: SHARES SUBSCRIBED TOTAL AMOUNT OF PAID-UP CAPITAL INSTRUCTION: SPECIFY THE TOP 20 STOCKHOLDERS AND INDICATE THE REST AS OTHERS Note: For PDTC Nominee included in the list, please indicate further the beneficial owners owning more than 5% of any class of the company's voting securities. Attach separate sheet, if necessary. TOTAL AMOUNT OF SUBSCRIBED CAPITAL 0.00 GIS_STOCK (v.2019) Page 6
TYPE NUMBER AMOUNT (PhP) % OF OWNERSHIP 15. TOTAL 16. TOTAL 17. TOTAL 18. TOTAL 19. TOTAL 20. TOTAL 21. OTHERS (Indicate the number of the remaining stockholders) TOTAL 0.00% Note: For PDTC Nominee included in the list, please indicate further the beneficial owners owning more than 5% of any class of the company's voting securities. Attach separate sheet, if necessary. INSTRUCTION: SPECIFY THE TOP 20 STOCKHOLDERS AND INDICATE THE REST AS OTHERS TOTAL AMOUNT OF SUBSCRIBED CAPITAL TOTAL AMOUNT OF PAID-UP CAPITAL 0.00 GENERAL INFORMATION SHEET STOCK CORPORATION ==================================== PLEASE PRINT LEGIBLY ================================== STOCKHOLDER'S INFORMATION SHARES SUBSCRIBED NAME, NATIONALITY AND CURRENT RESIDENTIAL ADDRESS AMOUNT PAID (PhP) CORPORATE NAME: TOTAL NUMBER OF STOCKHOLDERS: TOTAL ASSETS BASED ON LATEST AUDITED FS: NO. OF STOCKHOLDERS WITH 100 OR MORE SHARES EACH: TAX IDENTIFICATION NUMBER GIS_STOCK (v.2019) Page 7
CORPORATE NAME: 1. 1.1 1.2 1.3 1.4 1.5 2. 3. 4. 5. DIVIDENDS DECLARED DURING THE IMMEDIATELY PRECEDING YEAR: 5.1 CASH 5.2 STOCK 5.3 PROPERTY 6. AMOUNT (PhP) DATE OF BOARD RESOLUTION TOTAL P TREASURY SHARES TYPE OF DIVIDEND NO. OF SHARES % AS TO THE TOTAL NO. OF SHARES ISSUED DATE ISSUED: SECONDARY LICENSE/REGISTRATION WITH SEC AND OTHER GOV'T AGENCY: NAME OF AGENCY: SEC B S P I C TYPE OF LICENSE/REGN. TOTAL ANNUAL COMPENSATION OF DIRECTORS DURING THE PRECEDING FISCAL YEAR (in PhP) TOTAL NO. OF OFFICERS TOTAL NO. OF RANK & FILE EMPLOYEES INVESTMENT OF CORPORATE FUNDS IN ACTIVITIES UNDER ITS SECONDARY PURPOSES (PLEASE SPECIFY:) DATE NO. OF SHARES AMOUNT DATE OF BOARD RESOLUTION DATE OF STOCKHOLDERS RATIFICATION DATE STARTED OPERATIONS: NOTE: USE ADDITIONAL SHEET IF NECESSARY GENERAL INFORMATION SHEET STOCK CORPORATION PLEASE PRINT LEGIBLY OTHERS TOTAL MANPOWER COMPLEMENT INVESTMENT OF CORPORATE FUNDS IN ANOTHER CORPORATION UNRESTRICTED/UNAPPROPRIATED RETAINED EARNINGS AS OF END OF LAST FISCAL YEAR STOCKS BONDS/COMMERCIAL PAPER (Issued by Private Corporations) LOANS/ CREDITS/ ADVANCES GOVERNMENT TREASURY BILLS AMOUNT (PhP) DATE DECLARED ADDITIONAL SHARES ISSUED DURING THE PERIOD: GIS_STOCK (v.2019) Page 8
SUBSCRIBED AND SWORN TO before me in _______________________ on ____________________ by affiant who personally appeared before me and exhibited to me his/her competent evidence of identity consisting of _____________________ issued at ____________ on ___________________. NOTARY PUBLIC I, ___________________________________________, Corporate Secretary of ____________________________________________ declare under penalty of perjury that all matters set forth in this GIS have been made in good faith, duly verified by me and to the best of my knowledge and belief are true and correct. I hereby attest that all the information in this GIS are being submitted in compliance with the rules and regulations of the Securities and Exchange Commission (SEC) the collection, processing, storage and sharing of said information being necessary to carry out the functions of public authority for the performance of the constitutionally and statutorily mandated functions of the SEC as a regulatory agency. I further attest that I have been authorized by the Board of Directors/Trustees to file this GIS with the SEC. I understand that the Commission may place the corporation under delinquent status for failure to submit the reportorial requirements three (3) times, consecutively or intermittently, within a period of five (5) years (Section 177, RA No. 11232 ). Done this _______ day of ________________, 20 _____ in _____________________________. (Signature over printed name) GIS_STOCK(V.2019) Page9
Category A B C D E F G H I Note: This page is not for uploading on the SEC iView. 1 For Stock Corporattions. 2 For Non-Stock Corporattions. 3 For Stock Corporattions. Natural person(s) acting as stewards of the properties of corporations, where such properties are under the care or administration of said natural person(s). Natural person(s) who actually own or control the reporting corporation through nominee shareholders or nominee directors acting for or on behalf of such natural persons. Natural person(s) ultimately owning or controlling or exercising ultimate effective control over the corporation through other means not falling under any of the foregoing categories. Natural person(s) exercising control through positions held within a corporation (i.e., responsible for strategic decisions that fundamentally affect the business practices or general direction of the corporation such as the members of the board of directors or trustees or simlar body within the corporation; or exercising executive control over the daily or regular affairs of the corporation through a senior mangement position). This category is only applicable in exceptional cases where no natural person is identifiable who ultimately owns or exerts control over the corporation, the reporting corporation having exhausted all reasonable means of identification and provided there are no grounds for suspicion. % OF OWNERSHIP1 / % OF VOTING RIGHTS2 TYPE OF BENEFICIAL OWNER3
Direct (D) or Indirect (I) CATEGORY OF BENEFICIAL OWNERSHIP Description BENEFICIAL OWNERSHIP DECLARATION DATE OF BIRTH TAX IDENTIFICATION NO. COMPLETE NAME (Surname, Given Name, Middle Name, Name Extension (i.e., Jr., Sr., III) SPECIFIC RESIDENTIAL ADDRESS NATIONALITY “Beneficial Owner” refers to any natural person(s) who ultimately own(s) or control(s) or exercise(s) ultimate effective control over the corporation. This defination covers the natural person(s) who actualy own or control the corporation as destinguished from the legal owners. Such beneficial ownership may be determined on the basis of the following: Natural person(s) owning, directly or indirectly or through a chain of ownership, at least twenty-five percent (25%) of the voting rights, voting shares or capital of the reporting corporation. Natural person(s) who exercise control over the reporting corporation, alone or together with others, through any contract, understanding, relationship, intermediary or tiered entity. Natural person(s) having the ability to elect a majority of the board of directors/trustees, or any similar body, of the corporation. Natural person(s) having the ability to exert a dominant influence over the management or policies of the corporation. Natural person(s) whose directions, instructions,or wishes in conducting the affairs of the corporation are carried out by majority of the members of the board of directors of such corporation who are accustomed or under an obligation to act in accordance with such person's directions, instructions or wishes. Instructions:
GENERAL INSTRUCTIONS: 1. 2. 3. 4. 5. 6. 7. Deposits Insurance Products Loans Payment Services Others SEC ACCREDITATION NUMBER: TELEPHONE NUMBER(S): IF ENGAGED IN MICROFINANCE BUSINESS, CHECK SERVICES TO BE FILLED UP BY SEC PERSONNEL: NAME OF EXTERNAL AUDITOR & SIGNING PARTNER: INDUSTRY CLASSIFICATION CODE: NATIONAL GEOGRAPHICAL CODE (NGC): Money Transfer PRIMARY PURPOSE ENGAGED IN: DATE OF ACTUAL MEETING: COMPLETE BUSINESS FAX NUMBER(S): ADDRESS: EMAIL ADDRESS: WEBSITE/URL ADDRESS: COMPLETE PRINCIPAL OFFICE ADDRESS: TELEPHONE NUMBER(S): ONLY THE GIS ACCOMPLISHED IN ACCORDANCE WITH THESE INSTRUCTIONS SHALL BE CONSIDERED AS COMPLIANT WITH EXISTING RULES AND REGULATIONS. CORPORATE NAME: BUSINESS/ TRADE NAME DATE REGISTERED: FISCAL YEAR END: THIS GIS SHALL BE ACCOMPLISHED IN ENGLISH AND CERTIFIED AND SWORN TO BY THE CORPORATE SECRETARY OF THE CORPORATION. GENERAL INFORMATION SHEET (GIS) FOR THE YEAR _______________________ NON-STOCK CORPORATION FOR USER CORPORATION: THIS GIS SHALL BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE ANNUAL MEMBERS' MEETING AS STATED IN THE BY-LAWS. DO NOT LEAVE ANY ITEM BLANK. WRITE "N.A." IF THE INFORMATION REQUIRED IS NOT APPLICABLE TO THE CORPORATION OR "NONE" IF THE INFORMATION IS NON-EXISTENT.IF THE ANNUAL MEMBERS' MEETING IS HELD ON A DATE OTHER THAT STATED IN THE BY-LAWS, THE GIS SHALL BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS AFTER THE ELECTION OF THE DIRECTORS, TRUSTEES AND OFFICERS OF THE CORPORATION AT THE ANNUAL MEMBERS' MEETING. IF NO MEETING IS HELD, THE CORPORATION SHALL SUBMIT THE GIS NOT LATER THAN JANUARY 30 OF THE FOLLOWING YEAR. HOWEVER, SHOULD AN ANNUAL MEMBERS' MEETING BE HELD THEREAFTER, A NEW GIS SHALL BE SUBMITTED/FILED. THIS GIS MAY BE USED AS EVIDENCE AGAINST THE CORPORATION AND ITS RESPONSIBLE DIRECTORS/TRUSTEES/OFFICERS FOR ANY VIOLATION OF EXISTING LAWS, RULES AND REGULATIONS DATE OF ANNUAL MEETING PER BY-LAWS: CORPORATE TAX IDENTIFICATION NUMBER (TIN): ALL CHANGES ARISING BETWEEN ANNUAL MEETINGS AND AFFECTING THE INFORMATION STATED IN THE GIS, SUCH AS THE DEATH, RESIGNATION OR CESSATION OF HOLDING OF OFFICE OF A DIRECTOR, TRUSTEE, OR OFFICER, SHALL BE REFLECTED IN AN AMENDED GIS LABELED AS SUCH AND THE CHANGES CLEARLY HIGHLIGHTED. THE AMENDED GIS SHALL BE SUBMITTED WITHIN SEVEN [7] DAYS AFTER SUCH CHANGES OCCURRED OR BECAME EFFECTIVE. SUBMIT FOUR (4) COPIES OF THE GIS TO THE RECEIVING SECTION AT THE SEC MAIN OFFICE, OR TO SEC SATELLITE OFFICES OR EXTENSION OFFICES. ALL COPIES SHALL UNIFORMLY BE ON A4 OR LETTER-SIZED PAPER. THE PAGES OF ALL COPIES SHALL USE ONLY ONE SIDE. ================================ PLEASE PRINT LEGIBLY ===================================== SEC REGISTRATION NUMBER: ANNEX "C" GIS- NON-STOCK(v.2019) Page 1
A. 1. a. b. c. d. e. f. g. h. i. j. k. 2. a. b. a. c. b. d. e. f. g. h. c. i. j. 3. a. d. b. c. 7. d. a. e. f. b. g. h. c. i. j. k. d. l. m. 8. n. Describe nature of business: B. 4. Quasi-Banks Trust Entities Non-Stock Savings and Loan Associations Insurance Companies Insurance Agents 6. Company service providers which, as a business, provide any of the following services to third parties: acting as a formation agent of juridical persons Financial Institutions which Under Special Laws are subject to Bangko Sentral ng Pilipinas' (BSP) supervision and/or regulation, including their subsidiaries and affiliates. Jewelry dealers in precious stones, who, as a business, trade in precious stone Pawnshops Foreign Exchage Dealers Money Changers Remittance Agents Electronic Money Issuers 5. Securities Dealers acting as (or arranging for another person to act as) a Securities Brokers nominee shareholder for another person Insurance Brokers Professional Reinsurers Reinsurance Brokers Holding Companies Holding Company Systems acting as (or arranging for another person to act as) a director or corporate secretary of a company, a partner of a partnership, or a similar position in relation to other juridical persons Pre-need Companies providing a registered office, business address or accommodation, correspondence or administrative address for a company, a partnership or any other legal person or arrangement Mutual Benefit Association All Other Persons and entities supervised and/or regulated by the Insurance Commission (IC) Securities Salesman Persons who provide any of the following services: Investment Houses Investment Agents and Consultants managing of client money, securities or other assets Entities administering of otherwise dealing in valuable objects creation, operation or management of juridical persons or arrangements, and buying and selling business entities None of the above Trading Advisors management of bank, savings or securities accounts Other entities managing Securities or rendering similar services Mutual Funds or Open-end Investment Companies organization of contributions for the creation, Close-end Investment Companies operation or management of companies Common Trust Funds or Issuers and other similar entities GENERAL INFORMATION SHEET Corporate Name: Please check the appropriate box: Banks Offshore Banking Units Jewelry dealers in precious metals, who, as a business, trade in precious metals Is the Corporation a covered person under the Anti Money Laundering Act (AMLA), as amended? (Rep. Acts. 9160/9164/10167/10365) NON-STOCK CORPORATION ================================ PLEASE PRINT LEGIBLY ================================ Entities administering or otherwise dealing in cash Substitutes and other similar monetary instruments or property supervised and/or regulated by the Securities and Exchange Commission (SEC) Has the Corporation complied with the requirements on Customer Due Diligence (CDD) or Know Your Customer (KYC), record-keeping, and submission of reports under the AMLA, as amended, since the last filing of its GIS? Transfer Companies and other similar entities Other entities administering or otherwise dealing in currency, commodities or financial derivatives based there on GIS- NON-STOCK(v.2019) Page 2
NATIONALITY INCORPORATOR BOARD SEX OFFICER TAX IDENTIFICATION NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. FOR SEX COLUMN, PUT "F" FOR FEMALE,"M" FOR MALE. PRE-PRESIDENT CEO - CHIEF EXEC. OFFICER CFO - TREASURER COO - CHIEF OPERATING OFFICER COS - CORPORATE SECRETARY LEG - LEGAL COUNSEL AUD - EXTERNAL AUDITOR GOV - GOVERNMENT REPRESENTATIVE OTR - OTHERS N - NONE CORPORATE NAME: FOR BOARD COLUMN, PUT "C" FOR CHAIRMAN, "M" FOR MEMBER. GENERAL INFORMATION SHEET INSTRUCTIONS: FOR INCORPORATOR COLUMN, PUT "Y" IF AN INCORPORATOR, "N" IF NOT. NAME AND CURRENT RESIDENTIAL ADDRESS NON-STOCK CORPORATION ================================ PLEASE PRINT LEGIBLY ================================ D I R E C T O R S / O F F I C E R S FOR OFFICER COLUMN, INDICATE PARTICULAR POSITION IF AN OFFICER, SUCH AS: GIS- NON-STOCK (v.2019) Page 3
2.1 2.2 2.3 2.4 2.5 3. 3.1 3.2 3.3 3.4 3.5 4. FUND BALANCE (in PhP): 5. 5.1 5.2 5.3 DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT INVESTMENT OF CORPORATE FUNDS IN ACTIVITIES UNDER ITS SECONDARY PURPOSES (PLEASE SPECIFY:) GOVERNMENT TREASURY BILLS OTHERS DATE OF MEMBERS' RATIFICATION SECONDARY LICENSE/REGISTRATION/AUTHORITY/ACCREDITATION OTHER GOVERNMENT AGENCY: INSURANCE COMMISSION COMMISSION ON HIGHER EDUCATION LOANS/ CREDITS/ ADVANCES DATE OF BOARD RESOLUTION NOTE: USE ADDITIONAL SHEET IF NECESSARY NOTE: USE ADDITIONAL SHEET IF NECESSARY DATE ISSUED: DATE STARTED OPERATIONS: 9. TOTAL MANPOWER COMPLEMENT 7. TOTAL NO. OF OFFICERS DATE OF BOARD RESOLUTION 8. TOTAL NO. OF RANK & FILE EMPLOYEES 6.TOTAL ANNUAL COMPENSATION OF DIRECTORS/TRUSTEES DURING THE PRECEDING FISCAL YEAR (in PhP) TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY BANGKO SENTRAL NG PILIPINAS NAME OF AGENCY: DEPARTMENT OF EDUCATION BONDS/COMMERCIAL PAPER (issued by private corporations) STOCKS INVESTMENT OF CORPORATE FUNDS IN ANOTHER CORPORATION AMOUNT (in PhP) SEC REG. NO. GENERAL INFORMATION SHEET NON-STOCK CORPORATION ================================= PLEASE PRINT LEGIBLY ================================== ADDRESS INTERCOMPANY AFFILIATIONS PARENT COMPANY AFFILIATE SEC REG. NO. CORPORATE NAME: ADDRESS GIS- NON-STOCK (v.2019) Page4
SUBSCRIBED AND SWORN TO before me in _______________________ on ____________________ by affiant who personally appeared before me and exhibited to me his/her competent evidence of identity consisting of _____________________ issued at ____________ on ___________________. NOTARY PUBLIC I, ___________________________________________, Corporate Secretary of ____________________________________________ declare under penalty of perjury that all matters set forth in this GIS have been made in good faith, duly verified by me and to the best of my knowledge and belief are true and correct. I hereby attest that all the information in this GIS are being submitted in compliance with the rules and regulations of the Securities and Exchange Commission (SEC) the collection, processing, storage and sharing of said information being necessary to carry out the functions of public authority for the performance of the constitutionally and statutorily mandated functions of the SEC as a regulatory agency. I further attest that I have been authorized by the Board of Directors/Trustees to file this GIS with the SEC. I understand that the Commission may place the corporation under delinquent status for failure to submit the reportorial requirements three (3) times, consecutively or intermittently, within a period of five (5) years (Section 177, RA No. 11232 ). Done this _______ day of ________________, 20 _____ in _____________________________. (Signature over printed name) GIS-NON-STOCK(V.2019) Page5
Category A B C D E F G H I Note: This page is not for uploading on the SEC iView. 1 For Stock Corporattions. 2 For Non-Stock Corporattions. 3 For Stock Corporattions. TYPE OF BENEFICIAL OWNER3
Direct (D) or Indirect (I) CATEGORY OF BENEFICIAL OWNERSHIP COMPLETE NAME (Surname, Given Name, Middle Name, Name Extension (i.e., Jr., Sr., III) SPECIFIC RESIDENTIAL ADDRESS NATIONALITY DATE OF BIRTH TAX IDENTIFICATION NO. % OF OWNERSHIP1 / % OF VOTING RIGHTS2 Natural person(s) exercising control through positions held within a corporation (i.e., responsible for strategic decisions that fundamentally affect the business practices or general direction of the corporation such as the members of the board of directors or trustees or simlar body within the corporation; or exercising executive control over the daily or regular affairs of the corporation through a senior mangement position). This category is only applicable in exceptional cases where no natural person is identifiable who ultimately owns or exerts control over the corporation, the reporting corporation having exhausted all reasonable means of identification and provided there are no grounds for suspicion. BENEFICIAL OWNERSHIP DECLARATION “Beneficial Owner” refers to any natural person(s) who ultimately own(s) or control(s) or exercise(s) ultimate effective control over the corporation. This defination covers the natural person(s) who actualy own or control the corporation as destinguished from the legal owners. Such beneficial ownership may be determined on the basis of the following: Description Natural person(s) owning, directly or indirectly or through a chain of ownership, at least twenty-five percent (25%) of the voting rights, voting shares or capital of the reporting corporation. Natural person(s) who exercise control over the reporting corporation, alone or together with others, through any contract, understanding, relationship, intermediary or tiered entity. Natural person(s) having the ability to elect a majority of the board of directors/trustees, or any similar body, of the corporation. Natural person(s) having the ability to exert a dominant influence over the management or policies of the corporation. Natural person(s) whose directions, instructions,or wishes in conducting the affairs of the corporation are carried out by majority of the members of the board of directors of such corporation who are accustomed or under an obligation to act in accordance with such person's directions, instructions or wishes. Natural person(s) acting as stewards of the properties of corporations, where such properties are under the care or administration of said natural person(s). Natural person(s) who actually own or control the reporting corporation through nominee shareholders or nominee directors acting for or on behalf of such natural persons. Natural person(s) ultimately owning or controlling or exercising ultimate effective control over the corporation through other means not falling under any of the foregoing categories. Instructions: