IMPORTANT NOTICE: Expresspay is under the supervison of

Bangko Sentral ng Pilipinas (BSP) and in compliance to R.A 9160

the Anti-Money Laundering Act, this form should be
accomplished properly and completely for the franchise
application to be processed.

PLEASE PRINT LEGIBLY. Indicate N.A in the fields which are not
applicable
FRANCHISE APPLICATION FORM
FOR INDIVIDUAL/SOLE PROPRIETOR ONLY
First Name Middle Name Last Name
NAME:

GENDER Male MARITAL Single Widowed for ___ yrs. BIRTDATE BIRTHPLACE
Female STATUS Married Legally separated for __yrs. (mm/dd/yyyy)

NATIONALITY NO. OF CHILDREN SSS / GSIS NO. TIN

NO OF DEPENDENTS BENEFICIARY
(Other than children)

SPOUSE DETAILS
NAME OF SPOUSE
PERMANENT ADDRESS: EMAIL ADDRESS: MOBILE NO.:

NAME OF EMPLOYER / BUSINESS:

EMPLOYER / BUSINESS ADDRESS:

PARENTS DETAILS
MOTHER’s MAIDEN NAME OCCUPATION / BUSINESS:

FATHER’S NAME: OCCUPATION / BUSINESS:

ADDRESS DETAILS
PRESENT ADDRESS (Please check the box if this is also your mailing address)
No. / Street Barangay City / Municipality Zip Code

RESIDENCE TYPE LENGTH OF STAY TEL NO.

Owned Rented Living with parents Living with relatives ______ Years ______ Months

E-MAIL ADDRESS MOBILE PHONE NO. FAX NO.

EDUCATIONAL BACKGROUND
NAME AND ADDRESS OF SCHOOL INCLUSIVE DEGREE COMPLETED AWARDS / CITATIONS
YEARS
HIGH SCHOOL

COLLEGE

POST-GRADUATE

OTHER ACADEMICS
DEGREE/COURSES
PREVIOUS SEMINARS/TRAININGS ATTENDED/COMPLETED IN MANAGEMENT, SALES AND MARKETING, RETAILING OR CUSTOMER RELATIONS:
TRAINING / SEMINAR INCLUSIVE DATES CONDUCTED BY:

1
 IMPORTANT NOTICE: Expresspay is under the supervison of
Bangko Sentral ng Pilipinas (BSP) and in compliance to R.A 9160
the Anti-Money Laundering Act, this form should be
accomplished properly and completely for the franchise
application to be processed.

PLEASE PRINT LEGIBLY. Indicate N.A in the fields which are not
applicable
FRANCHISE APPLICATION FORM

WORK DETAILS (if currently employed)

NAME OF EMPLOYER:

EMPLOYER ADDRESS:

NATURE OF BUSINESS: EMPLOYMENT STATUS Start Date: _______________

Full-time Part-time Contractual End Date: _______________

OCCUPATION / PROFESSION: LENGTH OF SERVICE
_______ Years ________ Months
BUSINESS:

NAME OF BUSINESS:

BUSINESS ADDRESS:

NATURE OF BUSINESS: NO. OF YEARS IN BUSINESS

_________ Years _________ Months

DO YOU HAVE RELATIVES WORKING WITH EXPRESSPAY INC? YES NO

State Name and Relationship :

SOURCES OF FUNDS
In order for us to evaluate your personal ability to sustain an Expresspay franchise, please specify source of funding for this venture.
SALARY / WAGES:

BONUS / COMMISSIONS:

DIVIDENDS / INTEREST:

REAL ESTATE INCOME:

BUSINESS PROFITS:

NOTES / ACCOUNTS RECEIVABLES:

OTHER INCOME (specify sources, eg Trust, Spouse, etc)

TOTAL AVAILABLE FUNDS: P ____________________

TYPE OF BANK ACCOUNTS: BRANCH:

BUSINESS EXPERIENCE
Please indicate business/es currently operating and those which closed if any within the past 5 years.
PRESENT BUSINESS POSITION: YEARS IN BUSINESS:

BUSINESS ADDRESS (in full) TELEPHONE NO. EMAIL ADDRESS

2
 IMPORTANT NOTICE: Expresspay is under the supervison of
Bangko Sentral ng Pilipinas (BSP) and in compliance to R.A 9160
the Anti-Money Laundering Act, this form should be
accomplished properly and completely for the franchise
application to be processed.

PLEASE PRINT LEGIBLY. Indicate N.A in the fields which are not
applicable
FRANCHISE APPLICATION FORM
NATURE OF BUSINESS/TYPE TYPE OF BUSINESS OWNERSHIP
TOTAL NUMBER OF
MANUFACTURING EMPLOYEES AND LENGTH SINGLE PROPRIETORSHIP
OF SERVICE
FOOD/RESTAURANT PARTNERSHIP/ASSOCIATION
_______ ≤ 1 year
BANKING/FINANCE _______ ≤ 5years CORPORATION
_______ ≤ 10 years
MARKETING/ADVERTISING _______ > 10 years COOPERATIVE

RETAIL/WHOLESALE TRADING OTHERS: ___________________________________

OTHER _____________________________ YEARS OF OPERATION

PREVIOUS EMPLOYMENT EXPERIENCES

(Give exact names, addresses and dates. List most recent first. If necessary, use additional sheets)

DATE EMPLOYED POSITION NAME OF COMPANY TYPE OF BUSINESS

ADDRESS: NAME OF SUPERVISOR REASON FOR LEAVING

RESPONSIBILITIES

DATE EMPLOYED POSITION NAME OF COMPANY TYPE OF BUSINESS

ADDRESS NAME OF SUPERVISOR REASON FOR LEAVING

RESPONSIBILITIES

Please put a check on the appropriate

box.
OTHER INFORMATION YES NO
1. No. of Expresspay Franchise being applied for?
__________________

2. Is this the first time you are applying for an Expresspay franchise?

If NO, please give details of previous application and the applied franchise area.

3. Have you ever had an unsuccessful or losing business?

If YES, please provide details.

4. When and how did your business start?

5. Identify major milestones/developments in your business within the past five years (eg opening, expansion, renovation, etc)

6. How much time do you spend in your current business?

Daily Basis (in terms of number of hours) ______________________________________

Weekly Basis (in terms of number of days) ______________________________________

7. Will you be borrowing money to fund an Expresspay franchise?
Please specify.

3
 IMPORTANT NOTICE: Expresspay is under the supervison of
Bangko Sentral ng Pilipinas (BSP) and in compliance to R.A 9160
the Anti-Money Laundering Act, this form should be
accomplished properly and completely for the franchise
application to be processed.

PLEASE PRINT LEGIBLY. Indicate N.A in the fields which are not
applicable
FRANCHISE APPLICATION FORM
SOCIO-CIVIC AFFILIATIONS (eg Rotary, Lions, Jaycees, Mason, etc)
NAME ADDRESS POSITION INCLUSIVE YEARS

What were your personal contribution/s to the organization in the past two years?

Please indicate personal/business gains you got from joining the organizations.

REFERENCES
Bank/Credit References (Pls indicate contact person/s where accounts are held)
NAME ADDRESS HOW LONG KNOWN TELEPHONE NUMBER

Clients
NAME ADDRESS HOW LONG KNOWN TELEPHONE NUMBER

Suppliers
NAME ADDRESS HOW LONG KNOWN TELEPHONE NUMBER

BUSINESS PLANS
Which products/services in Expresspay’s business lines are you most interested in?

Where and how do you intend to promote these and other Expresspay products/services?

If you were granted a franchise, will you be directly involved in its operattion? Please describe nature and extent of participation?

If you are currently employed, how do you plan to manage the Expresspay business?

How much time can you spend in the management of an Expresspay business?

4
 IMPORTANT NOTICE: Expresspay is under the supervison of
Bangko Sentral ng Pilipinas (BSP) and in compliance to R.A 9160
the Anti-Money Laundering Act, this form should be
accomplished properly and completely for the franchise
application to be processed.

PLEASE PRINT LEGIBLY. Indicate N.A in the fields which are not
applicable
FRANCHISE APPLICATION FORM
Do you have any existing contractual business affiliations that may limit your involvement in an Expresspay business? Please give details.

Do you currently own a franchise business?

If YES, please state the Franchisor’s name, address, nature of business and date granted.

If you will be granted a franchise, who will have equity in the franchise? To what extent?

NAME RELATIONSHIP % SHARE ROLE

1. ___________________________________ ____________________________ _____________________ _________________________

2. ___________________________________ ____________________________ _____________________ _________________________

3. ___________________________________ ____________________________ _____________________ _________________________

Do any of the above-listed persons own a share/interest in another payment services/remittance franchise?
If YES, please gve details and extent of participation. YES NO
Do you have any pending application for other franchise?
If YES, please give details of your application. YES NO

PROFILE OF FRANCHISE APPLICANT Please put a check on the appropriate box

YES NO
1. Do you and/or your business have any pending legal cases in court?

If YES, please provide details.

2. Have you been taken to court over an employee-relations issue?

If YES, please provide details.

3. Are you or your spouse a foreign national?

If yes, ACR # ______________

4. Are you into politics?

Do you or any immediate family member hold a public government position? State
the current position.

5. Are you involved or in the business of armament manufacturing?

6. Are you involved or in the business related to casinos, betting or any gambling
activities?

7. Have you ever been charged of anything other than minor traffic violations?

Please give details: ___________________

8. Has any judgment ever been entered against you or your company or your
employer where you were one of the litigants?

9. Are you involved in any pending litigation?

5
 IMPORTANT NOTICE: Expresspay is under the supervison of
Bangko Sentral ng Pilipinas (BSP) and in compliance to R.A 9160
the Anti-Money Laundering Act, this form should be
accomplished properly and completely for the franchise
application to be processed.

PLEASE PRINT LEGIBLY. Indicate N.A in the fields which are not
applicable
FRANCHISE APPLICATION FORM
10. Have you ever been declared personal bankruptcy?

If YES to any of the above, please give details and inclusive dates. Use additional
pages if necessary.
11. Are you involved in any non-government organizations (NGOs) or any charitable
institutions?
12. Are you in any of the following business/profession:

Night Clubs / Pubs

Import / Export Companies

Precious metal, Jewelries, Art/Antique dealers

Foreign Exchange Operation e.g FX Remittance

Lawyer, Police, Military, Government Employee

Luxury Vehicle (car, boat, plane) dealers

I hereby certify that the above information is true and correct and that any material misrepresentation or falsity shall be construed as an act to defraud
the company for which I can be held civilly and / or criminally liable. I commit to inform the company in writing of any change in the foregoing
information herein provided. I hereby authorize Expresspay Inc. to verify and investigate any and all information herein as the company deems
appropriate.

I/We understand that upon acqusition of a franchise, I/we are required to undergo Expresspay’s Franchise System and other regulators (BSP, AMLC)
trainings.

___________________________________________ ___________________
Signature Over Printed Name Date

---------------------------------------------------------------------------FOR EPI USE ONLY---------------------------------------------------------------------------

APPROVED BY:

_____________________________________ _______________
Signature Over Printed Name Date