BROKER’S INFORMATION SHEET

Position Applied for: Sole Proprietorship

Data Privacy Policy

We at Federal Land, Inc. and Horizon Land (“The Company”) affirm, recognize, and acknowledge the need and urgency to treat the
security and privacy of your personal information with the highest regard at all times. Keeping this in mind, we prepared and
developed this Data Privacy Policy in order to let you know how we collect, store, use, and process your personal information as
well as to assist and guide you to make informed decisions.

This agreement will require further submission of plenary documents that may have your personal information which will be used
for the execution of this accreditation.

I confirm that I have read and understood Federal Land, Inc.'s and Horizon Land’s Data Privacy Policy statement and
do hereby give my acknowledgement and consent to Federal Land Inc. to use my personal data in accordance with their company
Data Privacy Policy.

testbbbbbbbbb a testnnnnnnnnnn 22nd January 2019

SIGNATURE OVER PRINTED NAME DATE

FOR INDIVIDUAL & SOLE PROPRIETORSHIP

Last Name: First Name: Middle Name:
testnnnnnnnnnn testbbbbbbbbb a
Address: makati
PRC License Number: 09876 Expiration Date: 2021-02-09
Gender: Female Landline Number: 0987654321 Citizenship: fil
Date of Birth: 5/6/1989 Age: 29 Civil Status: s
Mobile Number: 0987654321 Email Address: test@gmail.com
TIN Number : 134567432
BUSINESS TRADE NAME (FOR SOLE PROPRIETORSHIP, PARTNERSHIP & CORPORATION)
Name: n/a
Business Address: n/a
Office Number: n/a
Company TIN Number: n/a
AUTHORIZED REPRESENTATIVE (FOR CORPORATION & PARTNERSHIP)
Last Name: n/a First Name: n/a Middle Name: n/a
PRC License Number: n/a Expiration Date: 2021-01-01
Email Address: n/a Mobile Number: n/a Landline Number: n/a
I hereby affirm that the statements made by me in this form are true and correct. It is understood that, should this form contain any
willful misrepresentation or omission, reasonable proof of this fact will be sufficient justification for the termination of my accreditation.

I hereby expressly consent to the collection, use, sharing and processing of my personal information by the company or any of its
subsidiaries and affiliates for the purpose of the management and monitoring of this document, the performance of any agreement in
relation thereto, and for other authorized purposes, in accordance with the Data Privacy Act, and the company’s data protection
policy.

Testbbbbbbbbb A Testnnnnnnnnnn 22nd January 2019

Applicant’s Signature over Printed Name Date Signed

Conforme:

Test T Test 22nd January 2019

Division Head – Signature over Printed Name Date Signed

Test T Test 22nd January 2019

BRS – Signature over Printed Name Date Signed

Received by: Sales Support Services:

Signature over Printed Name Date Received