APPLICATION FOR ACCREDITATION

Real Estate Agent/ Broker/ BAS/ Contractor

Instructions: Please accomplish this Application form completely. Indicate NA if information is not applicable. Use additional sheet as necessary.
Purpose of Application Department Date
New Update Real Estate Loans Department Consumer Finance Business Center _______________________
Type of Applicant
Broker - Individual Contractor - Individual Buy-and-sell business - Individual
Broker - Company Contractor - Company In-house Agent of Developer (Name of Developer/s: __________________________________________)
COMPANY
Legal Business Name Trade Name Same as Legal Business Name

Business Address (No., Street, Village/ Municipality/ Barangay, City/ Town/ Province) Date of Incorporation

Phone Number/s E-Mail Address TIN Broker License No. (as applicable)

PERSONAL
Name of Applicant (Last Name, First Name, Middle Name) Nickname Broker License No. (as applicable)

Birthday (mm-dd-yy) Birthplace Age Gender Civil Status Nationality

Home Address (No., Street, Village/ Municipality/ Barangay, City/ Town/ Province) Length of Stay

Present/ Mailing Address (No., Street, Village/ Municipality/ Barangay, City/ Town/ Province) Same as above Length of Stay

Phone Number/s E-Mail Address TIN SSS/ GSIS Number

Highest Educational Attainment Name of School Degree

Name of Present Employer/ Business - For Individual Agent (Other than Developer), Broker, Contractor, or in Buy-and-Sell Business Nature of Work/ Business

Address of Employer/ Business (No., Street, Village/ Municipality/ Barangay, City/ Town/ Province)

Business Phone Number E-Mail Address Position/ Title

Date of Employment/ Incorporation Employment Status

Permanent Probationary Contractual Self-employed
FAMILY
Name of Spouse (Last Name, First Name, Middle Name) Nickname Birthday (mm-dd-yy)

Name of Employer/ Business Position/ Title Nature of Work/ Business

Name of Child/ Children and Age

INTERESTS
Hobbies/ Sports Leisure Activities (e.g., camping, watching movies) Special Skills/ Talents

AFFILIATION/S
Club/ Organization Membership Position Held Member Since

I hereby certify that all information given above are true and are made for the purpose of evaluating my application/ the application of the company I am
representing for accreditation.

Signature over Printed Name of Agent/ Broker/ Authorized Representative Date

UCPB Form No. 7-8058 2/2014
 FOR BANK USE ONLY
Name of Applicant Name of Developer (as applicable)

PRE-SCREENING YES NO NA DATE REMARKS

A. Pre-Approval Requirements
1. Valid ID/s with photo and signature
1.1 Driver’s License
1.2 Passport
1.3 SSS ID
1.4 TIN ID
2. Latest PRC ID and Certificate for Real Estate Broker
3. Valid ID issued by Developer - For In-House Agent
4. Additional Requirements - For Broker-Company and Contractor-Company
4.1 Secretary's Certificate/ Board Resolution (original)
4.2 DTI Registration Certificate (photocopy)
4.3 SEC Registration Certificate with Articles of Inc. and By-Laws (photocopy)
4.4 General Information Sheet on Key Positions in the Company (original)
4.5 Latest 3 years audited Financial Statements and Income Tax Returns (photocopy)
5. Deed of Sale - For Individual in the Buy-and-Sell Business

B . Eligibility Criteria
1. Currently at least 18 years old - For Individual Agent, Broker, Contractor, or in Buy-and-Sell Business
2. At least 3 years in the business - For Broker-Company and Contractor-Company
Result of Pre-screening Remarks
Qualified
Not Qualified

Pre-screened by Reviewed by

Signature over Printed Name of AO / Date Signature over Printed Name of Head - RELD/ CFBC / Date

EVALUATION YES NO NA DATE REMARKS

1. CMAP Check Negative Positive

2. File Check Negative Positive

3. Personal Data/ Residence and Neighborhood (PDRN) Report

4. Employment Verification Report (EVR)

5. Business Verification Report (BVR) - For Broker-Company and Contractor-Company

6. Trade Checking Negative Positive

7. Experience with other Bank on referrals Negative Positive

8. Court Cases Verification, if applicable
Result of CI Remarks
Approved
Dis-approved

APPROVING AUTHORITY

NAME SIGNATURE DATE ACTION REMARKS

Recommends

Endorses

Approves
 Payee's Information Sheet for Individual

Payee's Name
Last Name First Name Middle Name

Address

TIN

I hereby certify that all information declared in this sheet are true and correct and will be use by the bank for
BIR tax reportorial requirements.

________________________________
Payee Signature over Printed Name

Verified by Consumer Product Officer

_______________________________
Signature over Printed Name