ie } APPLICATION FORM FOR LICENSE TO OPERATE BUSINESS PROFILE BUSIRESS NARAE: [ERA RBORESS: | BUSINESS ADDRESS: _____ CONTACT NUMBER: RARE SSE PROVIDER: (paver Secon (RRS {_)cowrasirsecuamy once NATURE OF OWNERSHIP: {_} sour pRoPeToRSP { | CORPORATION {_} PARTNERSHIP SCOP _{ }LocAL RATIONAL INDICATE NUMBER OF BRANCHES FAN Luzon Visayas ‘Mindanao HCENSETO OPERATE APPUED FOR: (DN Janae [ HUME OF VERS Bua | NAME OF Ucensee, Sucre noMeE vaio HOME ADDRESS: TEL/CELLULAR PHONE NUMBER: Ee MANAGEMENT PROFILE A. ADMINISTRATION/OPERATION { aR T POSTON. [SO uCENSE NUMBER | ——VanomY I | i i | { L 5. BOARD OF DIRECTORS [For Corporation Only] . NAME POSITION: i SECURITY PERSONNEL PROFILE t FIREARMS PROFLE LESP CATEGORY (SG, 50, PA, PD, & Consultant) Number | Caliber i Number { mal i { Totat Total | LICENSE PROFILE (For old Applicant only) [a Ucensé to Operate Number ‘Authority and Date Granted Bapiry Date CRIMINAL ADSAIRESTRATIVE CASE PROPHE tus esselenir ees iat cial aimiiivatmycly nanycrareoree within tie Praines?_ yes, piesa spec boa) [= fisture of Case Where and When Filed | ‘Status/Disposition t i | i CERTIFICATION snare CERIN thet. al ttemens proved and documentary reatrememsstachd herein are tue, correct, valid and authentic ar alone Ut sated tern shall be a hss forte cancalatonteveaton of ay cense to Operate (LTO) without prejudice tothe fing of ‘andlor cil ease 2gainst me. SUBSCRIBED AND SWORN TO before methis_day of ss ee ie 2017. Aoplicant exhibited tome s/her LUCENSEE NAME & SIGNATURE Tie, lseued Doc No: