PACTT

PHILIPPINE ASSOCIATION OF
CERTIFIED TAX TECHNICIANS, INC
TEL. NO.: (054) 472-9104; Email: certtaxtech@gmail.com

MEMBER’S RECORD
MEMBERSHIP NO. _________
(To be filled-up by PACTT employee)

DATE: July 16, 2018

PERSONAL DATA

LAST NAME: DIPAD

FIRST NAME: LORENZO
MIDDLE NAME: DIAZ BEST PHOTO
SUFFIX if any (e.g. Sr, Jr) _______ Place of Exam: PRTC Cavite
DATE OF BIRTH: December 23, 1997 Date of Exam: May 19, 2018
CONTACT INFORMATION
(Please check where you want your certificate & id to be sent)
HOME ADDRESS: [√] BUSINESS/WORK ADDRESS: [ ]
House No.: Blk. 68 Lot 12 Phase 2 Company Name: ________________________________
Street/Zone: St. Matthew St. Position: ________________________________________
Brgy: CHRV Langkaan II Company Address: _______________________________
City/Municipality: Dasmariñas City _______________________________________________
Province: Cavite Cavite Phone Number/s: ________________________________
Mobile Number/s: 09263401748 Email Address: __________________________________
Email Ad: dipad674@gmail.com Facebook Account of Member_______________________

EDUCATIONAL/PROFESSIONAL INFORMATION
SCHOOL: FEU CAVITE PROFESSION: ________________________________
COURSE: BS in Accountancy LICENSE NUMBER: ____________________________
YEAR LEVEL: 5th Year YEAR GRADUATED: _________
SIGNATURE OF MEMBER
FACEBOOK ACCOUNT: Lorenz Diaz Dipad

*************************** to be filled-up only by a CTT employee ********************************

DATE OF PAYMENT RECEIPT NO. AMOUNT PAID

Membership Fee
Seminars Attended
Date of Seminar Place Date of Seminar Place