( N SECURITIES AND EXCHANGE COMMISSION > The following document has been received: Receiving: Mark Jason Orcine Receipt Date and Time: July 15, 2021 10:20:01 AM Company Information SEC Registration No.: CS200704327 Company Name: QF DISCOM NCR INC. Industry Classification: Company Type: Document Information Document ID: OST107152021869346 Document Type: GENERAL_|NFORMATION_SHEET Document Code: GIS. Period Covered: June 24, 2021 Submission Type: GIS Remarks: None“GENERAL INFORMATION SHEET (GIS) FORTHE YEAR 2021 ‘STOCK CORPORATION ‘GENERAL INSTRUCTIONS: FOR USR CORPORATION: THIS GIS SHOULD BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE ANNUAt| STOCKHOLDERS’ MEETING. DO NOT LEAVE ANY ITEM BLANK. WRITE “NL” IF THE INFORMATION REQUIRED IS NOT APPLICABLE 70 THE| ‘CORPORATION OR “NONE” IF THE INFORMATION 1S NON-EXISTENT. fF THE ANNUAL STOCKHOLDERS’ MEETING IS HELD ON A DATE OTHER THAN] ‘THAT STATED IN THE BY-LAWS, THE GIS SHALL BE SUBMITTED WITHIN THIRTY (30) CALENDAR. DAYS AFTER THE ELECTION OF THE DIRECTORS, ‘TRUSTEES AND OFFICERS OF THE CORPORATION AT THE ANNUAL MEMBERS" MEETING, 2 IFNO MEETING IS HELD, THE CORPORATION SHALL SUBMIT THE GIS NOT LATER THAN |ANUARY 30 OF THE FOLLOWING YEAR. HOWEVER, SHOULD AN ANNUAL STOCKHOLDERS’ MEETING BE HELD THEREARTER, A NEW GIS SHALL BE SUBMITTED /FILED. 5. THIS GIS SHALL BE ACCOMPLISHED IN ENGLISH AND CERTIFIED AND SWORN TO BY THE CORPORATE SECRETARY OF THE CORPORATION, 4 THE SEC SHOULD BE TIMELY APPRISED OF RELEVANT CHANGES IN THE SUBMITTED INFORMATION AS THEY ARISE. FOR CHANGES RESULTING FROM ACTIONS THAT AROSE BETWEEN THE ANNUAL MEETINGS, THE CORPORATION SHALL SUBMIT AMENDED GIS CONTAINING THE NEW INFORMATION| ‘TOGETHER WITH A COVER LETTER SIGNED THE CORPORATE SECRETARY OF THE CORPORATION. THE AMENDED GIS AND COVER LETTER SHALL B SUBMITTED WITHIN SEVEN (7) DAYS AFTER SUCH CHANGE OCCURED OR BECAME EFFECTIVE. ‘5. SUBMIT FOUR 4) COPIES OF THE GIS TO THE RECEIVING SECTION AT THE SEC MAIN OFFICE, ORTO SEC SATELLITE OFFICES OR EXTENSION OFFICES| ‘ALL COPIES SHALL UNIFORMLY BE ON A OR LETTER-SIZED PAPER. THE PAGES OF ALL COPIES SHALL USE ONLY ONE SIDE 6. ONLY THE iS ACCOMPLISHED IN ACCORDANCE WITH THESE INSTRUCTIONS SHALL HE CONSIDERED AS HAVING BEEN FILED. 1. THIS GIS MAY BE USED AS EVIDENCE AGAINST THE CORPORATION ANO ITS RESPONSIBLE DIRECTORS/OFFICERS FOR ANY VIOLATION OF EXISTING LAWS, RULES AND REGULATIONS. [CORPORATE NAME [DATE REGISTERED: (QF DISCoM. NER INC. 03/19/2007 [BUSINESS/TRADE NAME (QELDISCOM. NER, ING. isc YEAR END: SEC REGISTRATION NUMBER: cs200704327 December 21st IDATE OF ANNUAL MEETING PER BY-LAWS [CORPORA TORNTIFENTION rower cr) June so 7666694 [ACTUAL DATE OF ANNUAL MEETING: [NSE ADORE ze tunot NONE | COMPLETE PRINCIPAL OFFICE ADDRESS: ERICA Km, 14 West Service Road, Bray. Merville, Parafiaque City ‘fitiscom2020@ gmail.com [COMPLETE BUSINESS ADDRESS aR Km. 14 West Service Road, Bray. Merville, Paraftague ity 9823-8116 ‘DDH ‘ALTERNATE EMAIL ADDRESS ‘OFFICAL MOBILE NUMBER | AcTenvaTe ORC Wom “afldiscom2020@qmail.com ‘afics.iscom@gmallcom ‘0990-5890121 wea [NAME OF EXTERNAL AUDITOR & TS SIGNING PARTNER: ‘EE ACEREDTNTION BER [ORE RTE ferret] s3504-¢ 21-5116 PRIMARY PURPOSE ACTIVITY/INDUSTRY PRESENTLY ENGAGED IN INDUSTRY CLASSIFICATION: [GEOGRAPHICAL CODE] Distribution Wholesale Trade Other Services TINTERCOMPANY AFFILIATIONS PARENT COMPANY ‘SEC REGISTRATION NO. ADDRES ‘QUANTUM FOODS, INC. ‘AS0094-00009454 Kin 14 West Service Road Brgy. Merville, ParaRaque Clty ‘SUBSIDIARY AFFILIATE SEC HECISTRATIONNG. ADDRESS OTE USE DD TIONA EET NECESART ax srock.2000) PagetTGENERAL INFORMATION SHEET : STOCK CORPORATION PLEASE PRINT LEGIBLY OFIDISCOM NCR INC ‘Is the Corporation a covered person under the Anti Money Laundering Act (AMLA), as amended? (Rep. Acts. 9160/9164/10167/10365) [Please check the appropriate box: Yes Tanke >. Offshore Banking Units Quasi-Banks ‘Trust Entities .. Non-Stock Savings and Loan Associations Pawnshops Foreign Exchage Dealers Jewelry dealers in precious stones, who, as 2 Money Changers sO business trade in precious stone Remittance gents |. Blectronic Money Issuers Financial Institutions which Under Special Laws are subjectto Bangko Sontral ng Pilipinas (BSP) supervision and/or regulation, Company service providers which, a a business, Jnciuding ther subsidiaries and afl provide any ofthe following services to third partes: Jewelry dealers in precious metals, whe, 38 ol ‘business, rade in precious metals, goooo0o00000! Trsurance Companies Insurance Agents Ta acting asa formation agent of juridical persons Insurance Brokers Db acting as (orarranging for another person to acts} Professional Reinsurers director or corporate secretary ofa company, 8 Reinsurance Brokers partner of a partnership, or a similar position in Holding Companies rolation to other juridical persons Holding Company Systems Pre-need Companies Ce. providing a registered office, business address oF Mutual Benefit Association accommodation, correspondence or administrative ‘All Other Persons and entities supervised andor regulated by the address fora company, partnership or aay other Insurance Commission (10) legal person or arrangement Qa Qo Qa im Oo Qa Qo Q oO Securities Desens Ca. acting as (or arranging for another person to act 23) Securities Brokers ‘nominee shareholder for another person Securities Salesman Persons who provide any f the folowing services: 4. Investment Houses TT a marsaging ofclient money, secuides or other ase «Investment Agents and Constants 1. Trading Advisors 1b. management ofbank, savings or secures accounts Other entitles managing Secures or rendering similar services 1. Mutual Funds or Open-end Investment Companies 1 6 organtzation of contrtbutions forthe creation, 1. Cloge-end Investment Companies operation or management of companies J. Common Trust Funds or lsuers and other similar entities te Transfer Companies and other simlar entities 1 4 creation, operation or management ofjuridest C1 £ other entities administering or otherwise dealing In currency, persons or arangemens, and buying and selling commodities or financial derivative based thereon business ents Cl m. Entites administering of otherwise dealing in valuable objects 1 n. Entities administering or otherwise dealing in cash Substitutes and |" Describe ‘other similar monetary instruments or property supervised and/or] nature of regulated bythe Securit and Exchange Commission (SEC) business: 'E. Has the Corporation complied with the requirements on Customer Due Diligence (CDD) or Know Your Customer (KC), record-keeping, and submission of reports | C Yes @ No under the AMLA, as amended, since the last fling ofits GIS? oooooo0o08 ood tis,sTock(.2020) PagoGENERAL INFORMATION SHEET STOCK CORPORATION PLEASE PRINT LEGIBLY ==: [CORPORATE NAME: (FI DISCOM. NCR, INC (CAPITAL STRUCTURE [AUTHORIZED CAPITALSTOR ‘rreeorsuanes* | “OMBEROF | panssraren vauue [AMOUNT (PRP) nee) SHARES ib (0, ofshares X Par/Staed Value) ToMMON 0007005 Tg oO oO Tne sama ScD ARTA pa oor | sume or stones eraser ‘cor enuirino | stock: | tverorsuanes | me Stans faavosorrie] "vauae | AMOUNT | pens ie a} aN a Tal aes 7 Ton — rasa TE Tana FOREIGN NO.OF —— chovarenr | Sioa | rvmormunes- | Mamnor faiaasrri| eure | oor | ayy Sot | sass a | or i a [Percentage of Foreign uty Tora, [Tora Tora P| "TOTAL SUASCRIBED P| 3600700000) [PAID-UP CAPITAL NO.OF : | number oF seer wor ruuipino | stock. | tyre orsuanes Beno PAR/STATED VALUE amount (Par) — | gyytOh of como 600,009 79 7 A00 00000 Too ora] zat Tora POT FORRTER | “WOOF cnoveateny | stock: | tireorsnaness | S™MBEROF | panysratenvALuE rnaun nr) | gy Ep seman | wots wk we] Wm We wF 77 a00% Tora Toran) "TOTAL PAIDUPP a0 000.0) ‘NOTE: USE ADDITIONAL SHEET IF NECESSARY FF Common, Preferred or other casicaton [> Other than Directors Ofcers, Shareholders ong 100 af otanding sare cis srock (2020) PegsGENERAL INFORMATION SHEET STOCK CORPORATION we PLEASE PRINT LEGIBLY [CORPORATE NAME: GFTDISCOM. NCR, INC. DIRECTORS / OFFICERS Tock ‘NAME/CURRENT RESIDENTIAL ADDRESS | wavionatrTy] wc [soana]oawoeR] ST T once | SHES | TAKINENTIFCATION TOSARHELOTATR UIPRO Garman 149 Bera St Posadse Vilage v}c] om | ov [Parte | c ] 1220126000 Sues Murinupa Gy Boar Wala TERESAD-DAYRIT TINO tea 1597 Sebastian Se, Bagaguy wf foe |v [Petoa ac | 23994-40000 Valeniela ty vara "RENATO. RENDON LINO S105 ga Mansion #152 nga Se we fom | om |v Pricer} ac | 122.302-50s-000 Bray Slvacion Quenen Cy T-RONYSAN P-DELA CRUZ InCIPNO Bie Loe 1 Upper Bewtan Taguig we] fom |v | pissoe | m | 224372-056-000 ty © ROGELIOT DETACH LIPO i 922th Avenue Cubso, Quezon Cty wef {om Poy [oemmtel iy | ro294373.000 3 7 a a 7 i z 3 % % InSTROCTIN FOR SEX COLUMN, PUT"F* FOR FEMALE, “MT FOR MALE. FOR BOARD COLUMN, PUTC" FOR CHAIRMAN," FOR NEMBER, ‘Y FOR INDEPENDENT DIRECTOR, FORING'R COLUMN, PUT"Y" IF AN INCORPORATOR, "W" F NOT, FOR STOCKHOLDER COLUMN, PUT "Y" IF A STOCKHOLDER, "WF NOT. FOR OFFICER COLUM, INDICATE PARTICULAR POSITION IF AN OFFICER, FROM VP UP INCLUDING T ‘SECRETARY, COVPLIANGE OFFICER ANDIOR ASSOCIATED PERSON FOR EXECUTIVE COMMITTEE, INDICATE IF MEMBER OF THE COMPENSATION COMMITTEE; A’ FOR AUDIT COMMITTEE; "N" FOR NOMINATION {AND ELECTION COMMITTEE, ADDITIONALLY WRITE °C AFTER SLASH IF CHAIRNAN AND "UF MEMBER, {POSITION OF THE TREASURER, «1s stock (v2020) Page 4GENERAL INFORMATION SHEET STOCK CORPORATION = ane PLEASE PRINT LEGIBLY [ConPORATE NAME: ‘QFTDISCOM. NER, IN [TOTAL NUMBER OF STOCKHOLDERS: 6 FEO. OE PRET NTH SOY ORDO [TOTAL ASSETS BASED ON LATEST AUDITED FNANCIALSTATEMENTS: 11797548700 ‘STOCKHOLDERS INFORMATION SHARES SUBSCRIBED amount NAME, NATIONALITY AND CURRENT wor] AMOUNT. | axupewTiFIcaTion| ‘RESIDENTIAL ADDRESS swe | numer | AMOUNT | gyrate ‘NUMBER ne) wen | (Pay T GUANTIRE FOODS, INE [amon Texte) Peon fh 14 War Servi ad, tng vere so% | rencc0m | —o03.978.0e.200 estes tt "ForaL| —Fanaoa) 7a, TSAR IOTATE [ame Ta) Fa 419 tment. Fosdst vitage Soe] ee cama aaa ae Manila Cy "ToTAL) _7en000) Fava] SAAR TERESA ATR [ane Bao] SURAT 1577 Stas, Baghagin. Valenzuela iy ot a TOTAL] sana00) ——Foorp0009 TRETOT RDO [amon ane] Twa -RUPINO $105 fga Mansion, #252 Irn St. By re ane ae Satan Quezon Cty —rorai) ——aaaana] — T0000 © ROMSANP DHA CRU [omen aaa] spaea UPINO lc Lot 3 Upper Blew Taguig cty = | eee | Beacon TOTAL] 350000) spon] ‘© ROGHLIOT DEIR CRUZ aaa] Tana] i ae as pce lp 3% | s0a0000 | s02-44-373000 "TOTAL] ——saa000] sono) 7 TOTAL "TOTAL AMOUNT OF SUBSCRIBED CAPITAL 2,600,000.00] 100% nano TOTAL AMOUNT OF PAID-UP CAPITAL INSTRUCTION: SPECIFY THE TOP 20 STOCKHOLDERS AND INDICATE THE REST AS OTTERS [oer For POTCNomince ince in the It, please indicate further the Benfica owners cng re than 595 f any class of Oe Companys wang lccurtes. Auach eparatesheet if neesiry. is. stock (2020) PagesGENERAL INFORMATION SHEET STOCK CORPORATION [CORPORATE NAME: QFIDISCOM. NCR ING. i INVESTMENT OF CORPORATE “AMOUNT (PhPY DATE OF BOARD RESOLUTION FUNDS IN ANOTHER CORPORATION 1 STOCKS 7 i 12 BONDS/COMMERCIAL PAPER (Issued by Private Corporations) nie ws 13 LOANS/ CREDITS/ ADVANCES WA iA 14 GOVERNMENT TREASURY BILLS wa na 1S OTHERS x WK [2. INVESTMENT OF CORPORATE FUNDS IN ACTIVITIES UNDER ITS DATE OF BOARD RESOLUTION DATE OF ‘SECONDARY PURPOSES (PLEASE SPECIFY’) STOCKHOLDERS. N/A [s. TREASURY SHARES aoe ‘WASTOTHE TOTAL 7 NO. OF SHARES ISSUED N/A N/A [&._ UNRESTRICTED /UNAPPROPRIATED RETAINED FARNINGS AS OF END OF LAST FISCAL YEAR: NONE [S. DIVIDENDS DECLARED DURING THE IMMEDIATELY PRECEDING YEAR: NONE ‘TYPE OF DIVIDEND AMOUNT (PhP) DATEDECLARED S4_CASH NA NA 52 STOCK N/A WAL 53 PROPERTY N/A N/A ToTaL_| NVA ‘ADDITIONAL SHARES ISSUED DURING THEPERIOI DATE NO. OF SHARES ‘AMOUNT NA Na NR [NAME OF AGENCY: SEC BSP Te [rvPE OF JLIcENSE/REGN. sa wes nA [DATE IssUED: wa Wa WA JDATESTARTED JoPERATIONS: wal WA WA ‘TOTAL ANNUAL COMPENSATION OF DIRECTORS DURING THE PRECEDING FISCAL | TOTALNO. OF OFFICERS YEAR (in PhP) ‘TOTALNO. OF RANK & FILE EMPLOYEES N/A TOTAL MANPOWER, COMPLEMENT 10 TOTETSE ADDITONAL STEETIF NECESSARY. (s.sT0CK (¥2020) Pages1, ROGELIO |. DELA CRUZ , Corporate Secretary of _QFIDISCOM. NCR, ING, declare under penalty of perjury that all matters set forth in this GIS have been made in good faith, duly verified by me and to the best of my knowledge and belief are true and correct. Thereby attest that all the information in this GIS are being submitted in compliance with the rules and regulations of the Securities and Exchange Commission (SEC) the collection, processing, storage and sharing of said information being necessary to carry out the functions of public authority for the performance of the constitutionally and statutorily mandated functions of the SEC as a regulatory agency. | further attest that [ have been authorized by the Board of Directors/Trustees to file this GIS with the SEC. Iunderstand that the Commission may place the corporation under delinquent status for failure to submit the reportorial requirements three (3) times, consecutively or intermittently, within a period of five (5) years (Section 177, RA No. 11232), Done this__Itey br? awn ote (Signaturelover printed name) 3 mn MAKATI CITY a SUBSCRIBED AND SWORN TO before me in on by afflant who personally appeared before me and exhibited to me his/her competent evidence of identity consisting of (CTGH#17195431 issued at_Paraflaque City on January 18.2021. NOTARY PUBLIC atx, Jomy/bo\lico a. PONCE, JR. hotafy PUBLIC apromrifent fif mo? MAKATI CITY Doo. No, 27 MBER 31, 2021 Paseo W En Bane Resoation Book No. 7 Series of 2054 Gis.sTock(v2020) Page 7BENEFICIAL OWNERSHIP DECLARATION FORTHE YEAR: 2021 SEC REGISTRATION NUMBER: 5200704327 CORPORATE NAME: QFLDISCOM. NCR, INC. Instructions: 1. Identify the Beneficial Owner/s ofthe corporation as described in the Categories of Beneficial Ownership in items A tol below. List down as many as you can identify. You may use an additional sheet ifnecessary. 2. Fillin the required information on the beneficial owner in the fields provided for. 3, Inthe "Category of Beneficial Ownership” column, indicate the letter(s) corresponding thereto. In the event that the person identified as beneficial owner falls uncler several categories, indicate all the letters corresponding to such categories. 4 If the category is under letter “I’, indicate the position held (ie, Director/Trustee, President, Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, etc), 5. Donot leave any item blank, Write “N/A” ifthe information required is not applicable or "NONE" if non-existent. “Beneficial Owner" refers to any natural person(s) who ultimately own(s) or control(s) or exercise(s) ultimate effective control over the corporation. This definition covers the natural person(s) who actually own or control the corporation as distinguished from the legal owners, Such beneficial ownership may be determined on the basis of the following: Category Description A Natural person(s) owning, directly or indirectly or through a chain of ownership, atleast twenty-five percent (259%) ofthe voting rights, voting shares or capital of the reporting corporation, Natural person(s) who exercise control over the reporting corporation, alone or together with others, through any B contract anderstanding relationship, terme or teed ent Natural person(s) having the ably fo ectamajoy othe board of rectors /rstees, or any sma body of the corporation Natural ersn() having the ability to exert dominantinfuenc over the management ar pode ofthe ccrporation E Natural person(s) whose directions, instructions, or wishes in conducting the affairs of the corporation are carried cut by maori ofthe members ofthe board of rears a sich corporation who ae acexstome order an eblization fo atin acordance with such pesos deconstruction or wists Natural person(s) aingas towards te properties of corporations where such properties are under the cre oradsinctatonofsa tural pera 6 Natural person() who actualy ov or contol the reporting corporation through nominee shareholders or hominge director ating fo ron haf of uch natal persons H1 Natural person() mately owning or controling or exerting lima effective contol over the corporation through other means not falling under any of the foregoing categories. 1 Natur persons exersngcontrl through pctons bald witina corporation (e, responsbe fo strategie tecistons that fundamental affecthe busines practices general direction ofthe corporation suchs the members of the board of directors or trustees or similar body within the corporation; or exercising executive Control ver he daily or regular aaa the crporation tough seior management poston) Thisetegory ison apolicaleinexceptonal cases where onaural person dentable who ukimately om exer conto ver the corporation te reporting corporation having exaust al caso meas of eneeton and provided there ae no rounds fo sisi COMPLETE NAME bud (Surmme Gien | seeciic areor | 79% | gyn teelan,| BEES | carecony oF rime itieName, | nesipevtiat |xarionauy| °STEOF | prio] NERS BENEFICIAL Name Btnson(te,| ADDRESS 0. . owner owe? | re oer resent inde ieeneai Fara team ceveusora Sa no lugs x sl wos ssn sei aucoe areata: ‘Sear anatenssno oser| eyzua vais fueno | sr [seaman sep sope “sage Sony sowsor.newson | slinteSbenety eueno [augue es |zascsasco alo sone ct tr oe rraemecen ran sossuosoercnz|*"oacmnse” bueno | 8" [osusrsco ab sone ‘Note This page is no for uploading on the SECTew. * For Stock Corporations. * For Non-Stock Corporations ° For Stock Corporations