COVER SHEET

COMPANY REGISTRATION AND MONITORING

DEPARTMENT

Nature of Application SEC Registration Number

REGISTRATION

Company Name

Prime Scorpion Guardians Brotherhood Incorporated

Principal Office (No./Street/Barangay/City/Town/Province/

1798 LAWANG BATO SERVICE ROAD LAWANG BATO CITY OF VALENZUELA THIRD DISTRICT, PHILIPPINES

COMPANY INFORMATION
Industry Code Industry Description

S94990 Activities of other membership organizations, n.e.c.

Company's Email Company's Telephone Number/s Company's Mobile Number

jacudesin21@gmail.com 0917145228 09175228986

CONTACT PERSON INFORMATION

The designated person MUST be a Director/Trustee/Partner/Officer/Resident Agent of the Corporation

Name of Contact Email Address Telephone Number/s Mobile Number

Acudesin Jeffrey jacudesin21@gmail.com 0917-1452281 09175228986

To be accomplished by CRMD Personnel

Date Signature
Assigned

Document I.D.

Received by Corporate Filing and Records Division

Forwarded to:

Corporate and Partnership Registration

Green Lane Unit

Financial Analysis and Audit Division

Licensing Unit