LSP-NSB ANNEX 1 "ANNEX 1 FORM 1: DTLASSISTED MSMEs - PROFILE, NC-CLIENT PROFILE AND MONITORING SYSTEM (NC-CPMS) |CLIENT/CONTACT PERSON INFORMATION iN. [STATUS OF CuENT: Bother cient Assstes Dossting mst anew mswie Developed (osisterea) (vexistered) (Deisting MMe New usw Developed (onresstered) (oresatered) {somali Name [rece REF rR RE ——————— nL NRE tas RAE sor] ‘Boureuteebond artes Dsetenetoves Sse a psvote employee {B Urenploves laa [awit status [sasialCnasifcation ID mate Cremale |oisingle widowed lDabies indigenous Person [varies Bessy separated |G oierenty-Abied(PWO) senior cizen [aaaress oase/ulding Wo. Room & Ficor No. Building Name SveetName Barangay ‘ct Hesion Tip Code, [SONTACT DETAILS: [Telephone Number FaxNumber «Mobile Number __‘Emall Address Social Media/Website i Jtotynegoeye Carter the abovementioned insrmation or tain which are tue and core! to myfeur wrewdos, end the Vrs ha ompied wth a ls and reuaeons gowsring the establishment. maintenance a operon of my/our business we nereby trther declare that Le thei or consent to the callection, recording, merization, storage, use an! processing of the [sta or intsranon heron prowded fr the purpose of etablshing @databark which shall bea scarce ofall sation necessary [prrect montorna, research and polcy studs end rita caseination campaigns, ae roamed by Reputte Ack Nov Toss (eA) frosts), trees known os "Go Negev Act" IMoreosr, we hereby acknowledge and understand that while the DTYNogesyo Center endeava to Keep the infamation up to date an lconect. ine DTUNegosyo Corer. howewr. mates no reprosentaions or warenies of any Kin, express or imple, about tha] lcsmrictonoss. accurcy, relay, suitably oF ewaleity mth respect tothe information prouded and the same fe nutect to chang fwexe prior nce [Sire oa Pores a aie a =| IE WITH BUSINESS, PLEASE FIL UPr L_REGISTERED [UNREGISTERED |BUSINES5/CORPORATE/COOPERATIVE NAME. [RATE OF DIVSEC/COA/DOLE Jaccistaamion: jfanpicabier Morven COMPANY NAME: TRADE NAME OR BILLBOARD NAME: —_|1p0 REGISTRATION NO. [suswess ADDRESS/LOCATION: ioc 7 Roar Foor Na Wading Wane” aaa “faa rr [cONTACT BETA [Telephone Number Fax Number Mobile Number Email Address Social Medie/Website