PACTT

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

CTT FORM 02
MEMBER’S RECORD
MEMBERSHIP NO. _________
(To be filled-up by PACTT employee)

DATE: AUGUST
_____________________
28, 2018
PERSONAL DATA

LAST NAME: PATULOT

________________________________
FIRST NAME: ALLAN
________________________________
CARANDANG
MIDDLE NAME: ________________________________ BEST PHOTO
SUFFIX if any (e.g. Sr, Jr) _______ PRTC CALAMBA
Place of Exam: _____________________
DATE OF BIRTH: JULY 13, 1995
______________ JUNE 23, 2018
Date of Exam: _____________________
CONTACT INFORMATION
(Please check the address you want your Certificate & ID card to be sent)
HOME ADDRESS: [ / ] BUSINESS/WORK ADDRESS: [ ]
House No.: _____ Company Name: MUSTANG
________________________________
SECURITY AGENCY, INC
Street/Zone:________________________________
SAN JOAQUIN Position: ACCOUNTING STAFF
Brgy: _____________________________________
SAN PIOQUINTO # 89 LIM-AN ST., PASAY CITY
________________________________________
City/Municipality: MALVAR
____________________________ Company Address: _______________________________
Province: __________________________________
BATANGAS _______________________________________________
Mobile Number/s: ___________________________
09058556471 536-9770
_______________________________________________
allan_patulot@yahoo.com
Email Ad: __________________________________ Phone Number/s: ________________________________

EDUCATIONAL/PROFESSIONAL INFORMATION:
UNIVERSITY OF BATANGAS - LIPA CITY
SCHOOL: ________________________________________ PROFESSION: ________________________________
COURSE: ________________________________________
BACHELOR OF SCIENCE IN ACCOUNTANCY PRC LICENSE NUMBER: ________________________
YEAR LEVEL: _________
5 YEAR GRADUATED: _________
2017 SIGNATURE OF MEMBER
FACEBOOK ACCOUNT: ____________________________
facebook.com/allan.patulot.07.13.95

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

CTT NUMBER DATE OF PAYMENT RECEIPT NO. AMOUNT PAID

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