CPRS FORM 002 Rev 1

Client Profile Registration System (CPRS)

EXPORTER PROFILE INFORMATION

(for Partnership and Corporation)

DATA ITEM INFORMATION

Scanned Photo / Mandatory
(Please submit your logo in JPEG form)

Nature of Business / Mandatory TRADING OF GOODS IN WHOLESALE

(Pls. refer to your BIR Certificate of Registration Form 2303)

Business Name / Mandatory JSY COUNTERTRADING, INC.

Country of Citizenship / Mandatory FILIPINO

Address
Address / Mandatory NORTH POBLACION, LA LIBERTAD, NEGROS ORIENTAL
City / Mandatory DUMAGUETE CITY
Zip Code / Mandatory 6213
Country / Mandatory PHILIPPINES
Contact Information
Phone / Mandatory (02)651-5700 local 260
Alternate Phone / Optional (02)651-5700 local 359
Mobile Phone / Optional N/A
Fax / Optional (02)814-0098
Email / Mandatory alyanna.buenviaje@aaci.ph
URL/Website / Optional www.aaci.ph
Warehouse / Transit Shed Code / Optional N/A
Tax Identification Number / Mandatory 402-928-671
(Pls. refer to your BIR Certificate of Registration Form 2303)

Primary VASP CCN No. / Mandatory VA0000000051

Secondary VASP CCN No. / Optional N/A
PEZA-BOI Registration Number N/A
(if applicable)/CARR Code / Optional
SEC Registration No. / Mandatory CS20109336
Amount of Authorized Capital Stock / Mandatory PhP 11,000,000.00
Amount of Paid Up Capital / Mandatory PhP 11,000,000.00

This is to certify that all information in this page are true and correct.

Approved for CPRS registration by: EMILIO ILDEFONSO B. MONFORT

Signature over Printed Name of Authorized Company Officer Page 1 / 5
 CPRS Exporter Profile Information Company Name: JSY COUNTERTRADING, INC.

Related domestic & foreign companies

Related company 1 / Optional ALL ASIAN COUNTERTRADE INC.
Related company 2 / Optional N/A
Related company 3 / Optional N/A

Primary Broker / Mandatory (Please check In-House or Licensed Broker)

___In House
TIN (Default) 111-111-111-111
Code (Default) BR0000722111

__Primary Licensed Broker ( Please attach Broker's Certificate of Registration)

TIN/ Mandatory N/A
Code/ Mandatory N/A

Plant Addresses/ Mandatory to indicate at least one (1) Plant Address

Address / Mandatory BLU THUNDER WAREHOUSE, BURGOS EXTENSION,

RECLAMATION AREA
City / Mandatory BACOLOD CITY
Zip Code / Mandatory 6100
Country / Mandatory PHILIPPINES

Major Stockholders/ Mandatory to indicate at least one (1) Major Stockholder

First Name / Mandatory MICHAEL

Middle Name / Mandatory DE LEON
Last Name / Mandatory ESCALER
Country of Citizenship / Mandatory PHILIPPINES
TIN / Mandatory 106-102-918
Photo / Mandatory (Please submit in JPEG Form)

Signature / Mandatory (Original Signature)

Address
Address / Mandatory 1580 CYPRESS STREET, DASMARIÑAS VILLAGE
City / Mandatory MAKATI CITY
Zip Code / Mandatory 1221
Country / Mandatory PHILIPPINES
Phone / Mandatory (02)651-5737
Alternate Phone / Optional (02)651-5701
Mobile / Optional N/A
Fax / Optional (02)814-0098
Email / Mandatory michael.escaler@aaci.ph

Note: You may photocopy this page for multiple information entry .

This is to certify that all information in this page are true and correct.

Approved for CPRS registration by: EMILIO ILDEFONSO B. MONFORT Page 2 / 5

Signature over Printed Name of Authorized Company Officer
 CPRS Exporter Profile Information Company Name: JSY COUNTERTRADING, INC.

Principal Officers/ Mandatory to indicate at least one (1) Principal Officer

First Name / Mandatory EMILIO ILDEFONSO

Middle Name / Mandatory BENEDICTO
Last Name / Mandatory MONFORT
Position / Mandatory PRESIDENT
TIN / Mandatory 154-787-724
Photo / Mandatory (Please submit in JPEG Form)

Signature / Mandatory (Original Signature)

Address
Address / Mandatory ST. PETER AVENUE, DOÑA JULIANA HEIGHTS, BARANGAY
TACULING
City / Mandatory BACOLOD CITY
Zip Code / Mandatory 6100
Country / Mandatory PHILIPPINES
Phone / Mandatory (02)651-5717
Alternate Phone / Optional (02)651-5700
Mobile / Optional N/A
Fax / Optional (02)814-0098
Email / Mandatory emil.monfort@aaci.ph

Responsible Officers/ Mandatory to indicate at least one (1) Responsible Officer

First Name / Mandatory EVELYN

Middle Name / Mandatory MANABAT
Last Name / Mandatory PEÑALOZA
Position / Mandatory TREASURER
TIN / Mandatory 101-586-918
Area of Responsibility / Mandatory ACCOUNTING
Photo / Mandatory (Please submit in JPEG Form)

Signature / Mandatory (Original Signature )

Address
Address / Mandatory 25 TELSTAR STREET, VILLAGE EAST, CAINTA
City / Mandatory RIZAL
Zip Code / Mandatory 1800
Country / Mandatory PHILIPPINES
Phone / Mandatory (02)651-5775
Alternate Phone / Optional (02)651-5700
Mobile / Optional N/A
Fax / Optional (02)814-0098
Email / Mandatory eva.penaloza@aaci.ph
Note: You may photocopy this page for multiple information entry.
This is to certify that all information in this page are true and correct.

Approved for CPRS registration by: EMILIO ILDEFONSO B. MONFORT

Signature over Printed Name of Authorized Company Officer Page 3 / 5
 CPRS Exporter Profile Information Company Name: JSY COUNTERTRADING, INC.

Major Suppliers / Mandatory to indicate at least one (1) Major Supplier

TIN / Mandatory 000-962-642

Name / Mandatory DOS HERMANAS MULTIPURPOSE COOP.
Address
Address / Mandatory CORNER FILIPINA MABINI STREET, TALISAY CITY

City / Mandatory NEGROS OCCIDENTAL

Zip Code / Mandatory 6115
Country / Mandatory PHILIPPINES
Phone / Mandatory (034)495-0353
Alternate Phone / Optional N/A
Mobile / Optional (639)17-703-7351
Fax / Optional N/A
Email / Mandatory dhmpci_talisay@yahoo.com

Note: You may photocopy this page for multiple information entry.

This is to certify that all information in this page are true and correct.

Page 4 / 5
Approved for CPRS registration by: EMILIO ILDEFONSO B. MONFORT
Signature over Printed Name of Authorized Company Officer
 CLIENT PROFILE REGISTRATION SYSTEM (CPRS) INFORMATION

Please fill up all information. Do not leave any information blank. If not applicable,
please indicate not applicable.

Company Name: JSY COUNTERTRADING, INC.

TIN Number : 402-928-671
Office Address: NORTH POBLACION, LA LIBERTAD, NEGROS ORIENTAL
Warehouse/Plant Address: BLU THUNDER WAREHOUSE, BURGOS EXTENSION, RECLAMATION AREA, BACOLOD CITY
Product Lines/Services: SUGAR & MOLASSES
Export Products for CPRS: SUGAR & MOLASSES
With BOC AMO (Account Management Office)accreditation?

________Yes Imported Materials:________________________________________

____X___ No

Export Performance for the Past Year (if none, pls. indicate “No Export”)
Products Exported: NO EXPORT
Value (Pesos): NO EXPORT
How many times per year: NO EXPORT
Countries of Export: NO EXPORT
For Corporations:
Authorized Capital Stock: PhP 11,000,000.00 as of 2018
Paid-Up Capital Stock: PhP 11,000,000.00 as of 2018
Total Assets: PhP 108,501,413.00 as of 2018

No. of Employees:
Office Plant
Regular 3 0
Contractual 0 2

Organizations/Associated Membership: N/A

Trade Fairs Participated (Local & International) : N/A

Accomplished By:

Name of Person: EMILIO ILDEFONSO B. MONFORT

Signature over printed Name

Position: PRESIDENT

Contact No/s: (02)651-5717/(02)651-5700

Date: JULY 2, 2019

NOTES: * This form is to be filled up by Authorized Representative as per the submitted

Secretary's Certificate.
* The form is to be attached to the revised CPRS Application Form (if with changes)
or the Affidavit of No Change and included among the pages to be notarized.

SUBSCRIBED AND SWORN to before me this ________ day of__________________,(CPRS Official Representative), exhibiting to
me his/her Community Tax Certificate No.______________________ issued on________________________ at _______________,
Philippines.
NOTARY PUBLIC
Doc. No. _________
Page No. _________
Book No._________
Series No. ________
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