CONTROLNO PCONTROLNO RTC FXD RA RPP EMI RDA RANP

VC RSA OTHERS FXDREGNO BUSSLINE MSBACTION

DATESTARTTERM
CONTROLNO SALNAME LSTNAME FRSTNAME MIDNAME EXTNAME
BO-1 Ms. LOZADA SIDNEY ONCADA
CTZENSHP ADDRESS1 ADDRESS2 BRGY TOWN PROV
FILIPINO BLK 10 LOT 4 SOUTH GROVE BARANGAY 8-A (POB.) CITY OF DAVAO DAVAO DEL SUR
 REGN ZIPCODE TIN TELNO MOBNO FAXNO
DAVAO REGION (S-MIN 8000 267-344-931 (082) 224-1771 0998-567-3035
 EMAILADD CITIZENCLASS
sidney.wink@gmail.co Filipino Resident
CONTROLNO SALNAME LSTNAME FRSTNAME MIDNAME EXTNAME CTZENSHP
OPBOD-1 Ms. LOZADA SIDNEY ONCADA FILIPINO
 ADDRESS1 ADDRESS2 BRGY TOWN PROV REGN ZIPCODE
BLK 10 LOT 4 SOUTH GROVE BARANGAY 8-A (POB.CITY OF DAVAO DAVAO DEL SUR DAVAO REGION (S-M8000
POSITION TIN TELNO MOBNO FAXNO EMAILADD
Proprietress 267-344-931 (082) 224-1771 0998-567-3035 sidney.wink@gmail.com
 NOSHARES AMTCONTR POWNRSHP CITIZENCLASS
ey.wink@gmail.com 300,000.00 100.00 Filipino Resident
AMLADATE
44752
CONTROLNO PCONTROLNO SHARETYPE CORPNAME SALNAME LSTNAME
FRSTNAME MIDNAME EXTNAME CTZENSHP ADDRESS1 ADDRESS2
BRGY TOWN PROV REGN ZIPCODE TIN
TELNO MOBNO FAXNO EMAILADD NOSHARES
AMTCONTR POWNRSHP CITIZENCLASS
CONTROLNO SHARETYPE CORPNAME SALNAME LSTNAME FRSTNAME
MIDNAME EXTNAME CTZENSHP ADDRESS1 ADDRESS2 BRGY
TOWN PROV REGN ZIPCODE TIN TELNO
MOBNO FAXNO EMAILADD NOSHARES
AMTCONTR POWNRSHP CITIZENCLASS
CONTROLNO PCONTROLNO TICKETING PREPAIDC ELOADING BILLSPAY INSURANC
COURIERS MLOAN OTHERDSC BUSSLINE
CONTROLNO PCONTROLNO SALNAME LSTNAME FRSTNAME
LO-2 HO-1 Ms. ALIDO MARYFLOR
LO-3 HO-1 Ms. LOZADA SIDNEY
MIDNAME EXTNAME CTZENSHP ADDRESS1 ADDRESS2
SISON FILIPINO BLK 11 LOT 7 PHASE 1 SAN ANTONIO
ONCADA FILIPINO BLK 10 LOT 4 SOUTH GROVE
 BRGY TOWN PROV REGN ZIPCODE
AGDAO CITY OF DAVAO DAVAO DEL SUR DAVAO REGION (S-MINDA 8000
BARANGAY 8-A (POB.) CITY OF DAVAO DAVAO DEL SUR DAVAO REGION (S-MINDA 8000
POSITION TIN TELNO MOBNO FAXNO
Marketing Officer 940-163-528 0907-123-0040
Branch Manager/OIC 267-344-931 (082) 224-1771 0998-567-3035
 EMAILADD PSAMLAAT AMLADATE
flor17libra@gmail.com
sidneywink@gmail.com
CONTROLNO FULLINST INSTNAME BUSSNAME ADDRESS1 ADDRESS2
HO-1 KIMSOR PAWNSHOP KIMSOR PAWNSHOP KIMSOR PAWNSHOP HRTV BLDG CORNER RIZAL-BOLTON
 BRGY TOWN PROV REGN ZIPCODE SHRTADDR
BARANGAY 38-D (POB.) CITY OF DAVAO DAVAO DEL SUR DAVAO REGION (S-MIND 8000 HRTV BLDG CORNER RIZAL-BOLTON STREETS, BAR
 EOADDR DTISECNO DTISECDI DTISECDV BUSPRTNO BUSPRTDI
DG CORNER RIZAL-BOLTON STREETS, BAR4186029 9/23/2022 9/23/2027 B-27773-3 3/23/2022
BUSPRTDV TIN TELNO MOBNO FAXNO WEBSITE
12/31/2022 267-344-931-002 (082) 224-1771 0999-567-3035 n.a.
 EMAILADD OWNRTYPE PSREGNO CLASS HASCA DATEOPEN
kimsorp@yahoo.com SINGLE PROPRIETORSHIP A NO
DATECLOSE OLDBUSSNAME OLDADDRESS DATELOCCLOSE DATETRANSFER MSBCLASS
AUTHCAPSTOCK MSBREGNO BSPREGNO RCLOSURE
300000
 In support of this application, I submit the following:
1. Proof of Financial Capacity
a. For New Entity: Treasurer's Affidavit or Bank Certification
b. For Existing Entity: Latest Audited Financial Statement
2. The documentary requirements listed in FSS Licensing Form No. 01-002

REPUBLIC OF THE PHILIPPINES )

CITY ) S.S.

I, , solemnly swear that all matters set forth on these statements are true and
correct to the best of my knowledge and belief.

(Signature over Printed Name of

Proprietor/Managing Partner/President/
Officer of equivalent rank and function)

Designation

SUBSCRIBED AND SWORN to before me this _____ day of __________________ 20_____, in the City/
Municipality of ______________________________, by:

Name Gov't. ID No. Valid Until

NOTARY PUBLIC

Doc. No. _________

Page No. _________
Book No. _________
Series of 20____

FSS Licensing Form No. 01-001 * Version 1 * File/Ref. No.___________ * Page 2 of 2

 APPLICATION FOR AUTHORITY TO OPERATE A PAWNSHOP BUSINESS
(To be completely filled up. Indicate "NA" if an item is not applicable)

Thru: The Office of the Director Date: 11-Oct-22

Financial Supervision Department IX

Pursuant to Presidential Decree No. 114 and Manual of Regulations for Non-Bank Financial Institutions (MORNBFI)– Pawnshop (P)
Regulations, as amended, I hereby apply for Authority to Operate a Pawnshop Business:
1 CLASSIFICATION OF PAWNSHOP OPERATOR LICENSE
A - Pawnshop business with not more than ten (10) offices.

A
B - a. Pawnshop business with more than ten (10) offices; or
b. Pawnshop business with money changing/foreign exchange dealing.
C - Pawnshop business with corollary remittance activity requiring Bangko Sentral registration, with or without money changing/
foreign exchange dealing.
D - Virtual pawnshop operators or those engaged in pawnshop business through electronic pawning (e-pawning) which refer to
systems and processes that enable customers to pawn their personal property through electronic channels.

2 FULL COMPANY NAME (as appearing in KIMSOR PAWNSHOP 3. TIN 267-344-931-002

the DTI/SEC Registration)
KIMSOR PAWNSHOP
4 COMPANY NAME
5 REGISTERED BUSINESS/TRADE KIMSOR PAWNSHOP
NAME/S
6 DTI / SEC REGISTRATION NO. 4186029 7. Date Issued 23-Sep-22 8. Valid Until 23-Sep-27
9 BUSINESS LOCATION If within a Bldg., specify stall, room, floor
Street No. & Name / Purok Barangay
number

HRTV BLDG CORNER RIZAL-BOLTON STREETS BARANGAY 38-D (POB.)

City/Municipality Province

CITY OF DAVAO DAVAO DEL SUR

Landline Mobile No. Email address 1/

Website
10 CONTACT INFO.
(082) 224-1771 0999-567-3035 kimsorp@yahoo.com n.a.

11 BUSINESS PERMIT/ NATURE or TYPE Business Permit No. Date Issued Valid Until Kind of Business
OF BUSINESS
B-27773-3 23-Mar-22 31-Dec-22 Pawnshop

12 FORM OF BUSINESS ORGANIZATION 13. TOTAL EQUITY 300,000.00

SINGLE PROPRIETORSHIP

14 BENEFICIAL OWNER/S2/
Name Citizenship Address TIN Landline Email address
SIDNEY ONCADA LOZADA FILIPINO CITY OF DAVAO, DAVAO DEL SUR 267-344-931 (082) 224-1771 sidney.wink@gmail.com
15 OWNERSHIP AND MANAGEMENT STRUCTURE
15.1 List of Board of Directors / List of Partners / Owner
% of
Name Citizenship Address Position TIN Amount of Contribution Email address
Ownership

SIDNEY ONCADA LOZADA FILIPINO CITY OF DAVAO, DAVAO Proprietress 267-344-931 300,000.00 100 sidney.wink@gmail.com
DEL SUR
15.2 List of Shareholders
% of
Name Citizenship Address TIN Amount of Contribution Email address
Ownership

15.3 List of Key Officers

Name Citizenship Address Position TIN Email address
MARYFLOR SISON ALIDO FILIPINO CITY OF DAVAO, DAVAO DEL SUR Marketing Officer 940-163-528 flor17libra@gmail.com
SIDNEY ONCADA LOZADA FILIPINO CITY OF DAVAO, DAVAO DEL SUR Branch Manager/OIC 267-344-931 sidneywink@gmail.com

1/
Shall be considered the official e-mail address registered with BSP
2/
Refers to natural person(s) who ultimately owns or controls the pawnshop. It also includes those persons who exercise ultimate effective control over a legal person or
arrangement

FSS Licensing Form No. 01-001 * Version 1 * File/Ref. No.___________ * Page 38 of 2