CIS Form

CUSTOMER INFORMATION SHEET DATE: Oct. 29, 2019

Company Name: SVX Trading
Office Address: Block 8 Lot A3 Magnolia st. Gardens of Maia Alta, Antipolo City

Applicant's Name: Emmanuel O. Peredo Jr.

SEC Registration No. Tax Identification No:
Nature of Business: Trading Business Establishment Date:
Business Classification: Corporation X Sole Proprietorship Partnership

Personal Information
Name of the Owner: Emmanuel Jr. Olmos Peredo
Given Name Middle Name Surname
Mother's Maiden Name: Natividad Olmos Peredo
Date of Birth: May 18, 1960 Place of Birth: Malolos Bulacan
Civil Status: Married Nationality: Catholic
Home Address: Block 8 Lot A3 Magnolia st. Gardens of Maia Alta, Antipolo City
Years of Stay: 15 Home Ownership: X Owned Living with parents
Telephone Numbers: Rented Living with relatives
Mobile Numbers: 9178159736 Mortgaged
E-mail Address eperedo60@yahoo.com

Collection Information (Please indicate AS ABOVE if it is the same as Customer Information)

Collection Address: Same as above
Contact Name: Jay-ar Balagosa
Designation: Administrative Assistant
Telephone Numbers: 5717201 Fax:
E-mail Address: jbalagosa.svxtrading@gmail.com Mobile No: 9651162921
Collection Schedule:

Delivery Information (Please indicate AS ABOVE if it is the same as Customer Information)

Delivery Address: Same as above

Contact Name: Jay-ar Balagosa

Designation: Administrative Assistant
Telephone Numbers: 5717201 Fax:
E-mail Address: jbalagosa.svxtrading@yahoo.com Mobile No: 9651162921

Credit Information (fill up at least one)

BANK 1 BANK 2 MMFC REQUIREMENTS:
Name: China Bank PS Bank 1 Company profile
Branch: Antipolo Branch Antipolo Branch 2 Photocopy of ID's
Account Name: Emmanuel O. Peredo Jr. Emmanuel O. Peredo Jr. 3 SEC / DTI Registration
Account # : 1191-0000-2075 114361005290 4 Business Permit
Contact Name: Zyke 5 BIR Registration
Designation: 6 Latest credit card statement
Telephone Numbers: 9178329919 7 Proof of billing of any ulitities under
the name of entity or the owner
SUPPLIER 1 SUPPLIER 2 8 Latest audited financial statement
Name: QPLC Nutri Fresh 9 At least one piece ID picture of the
Merchandise Supplied: Dressed Chicken Dressed Chicken signatory / signatories
Contact Name: Pablito Bufilo Sonny Magtibay 10 Articles of Incorporation/Partnership
Designation: Sales Coordinator Sales Maneger
Telephone Numbers: 9094761336 9237031226
Credit Term: 3 Days 4Days
APPROVED BY:
PREPARED BY: I hereby certify that the information in this document are
all true and correct.
Emmanuel O. Peredo Jr. Proprietor 10/29/19
Signature Over Printed Name / Position / Date Emmanuel O. Peredo Jr. Proprietor 10/29/19
Signature Over Printed Name / Position / Date
FOR MMFC USE ONLY
APPROVED TERMS:

APRROVED BY: