SUPPLIER APPLICATION FOR REGISTRATION FORM

Important Note: Please send a copy of your cancelled check and/or your wire instructions
Type of Request Country
Create X PH X MY Remarks:
Change BD SG
Others TH ID
Country and Company Code
X Philippines (PH) Malaysia (MY) Bangladesh (BD)
X Apo Cement Corporation CEMEX Aggregates (Penang) CEMEX Cement Bangladesh
Solid Cement Corporation CEMEX Concrete (Malaysia)
Island Quarry & Aggregates Corp CEMEX Holdings (Malaysia) Singapore (SG)
Apo Land & Quarry Corporation CEMEX Aggregates(Central) CEMEX Asia Pte
CEMEX Asia Pte. Ltd-PHQ CEMEX Asphalt (Malaysia) Thailand (TH)
CEMEX Strategic Philippines Inc. CEMEX Aggregates (M) Sdn CEMEX (Thailand) Co. Ltd.
CEMEX Philippines Foundation CEMEX Aggregates(Kelantan Indonesia (ID)
EcoCrete Inc. CEMEX Asia Holdings PT Cemex Indonesia
Enerhiya Central Inc.
Account Group
Suppliers X Haulers Drivers Plant Company Employee
General Data
Title
Company Partnership Corporation X Single Proprietorship Plant
Commercial Name

Street Address
Building Code Room Floor
House No. / Street Brgy. 75 Fatima Village
City/State/Zip Code Tacloban City, Leyte Zip Code 6500
Country Philippines
PO Box Address
PO Box Postal Code Company Postal Code
Communication
Language Fax Mobile Phone 09278288901
Telephone (053) 832-4123 Email aep_signshop@yahoo.com
Tax Information
Tax Number 282-384-268-000 Tax Type VAT
Vat Registration No.
Type of Business Type of Industry
Type of Business / Industry
Additives/Grinding Aid Dynamic Balancing/Crack Tstn Heavylift Services
X Advertising Elec'L & Instru Equipt/Parts Helicopter
Affiliates/Officers Electrical Supplies Hotel Accommodation
Aircon Units,Parts,Services Empty Cement Bags Ind'L Machinery/Equipt/Service
Blowers/Dampers/Fan Assembly Engineering Services Ind'L Supplies
 Brokerage Environmental Services/Supply Industrial
Bulk Materials Equipment/Service Rentals Industrial Bearings
Car/Service Dealer Exclusive Distributor IT Consultancy
Castings/Foundry Explosives Limestone
Cement Plant Explosives Manpower Services
Chains/Elevators/Rollers Fabrication Miscellaneous/Others
Chem/Packing/Seals/Gasket Filter Bags/Airslide Canvass Office Equipt/Supplies/Service
Coal Firebricks/Castables Oxygen/Acetylene/Other Gases
Commercial Furnitures&Fixtures Packaging
Computer Hard/Soft Wares General Contractor Petcoke
Consultancy General Mill Supplies Pneumatic/Hydraulic Equipt
Conv.Belts/Vulca'Zing/Splicing Genset Equipt,Parts & Services Power Dist/Transf/Drives
Cooperatives/Associations Government Agency/Dept Printing Services
Courier Gypsum Pumps & Compressors
Crusher Equipt/Parts Hauling Services Pyrite Cinders
Deepwell Drilling Access/Parts He & Light Equipt Parts/Serv. Quarrying/Crushing
Drilling And Blasting Heavy Motors Recapping
Bank Details
Country Bank Key Bank Account Account Holder IBAN Value Reference Details
Philippines 1120-0063-86 Avelino Moreno Pinpin Jr.
Bank Data
Bank Country PH Bank Key
Address
Bank Name Bank of the Philippine Islands ( BPI)
Region 8 Street Justice Romualdez
City Tacloban City
Bank Branch BPI-Justice Romualdez Branch
Control Data
SWIFT Code Post Bank Account Bank Number
Contact Person
Name Telephone Department Function

Company Code Data

Payment Data
Payment Terms
2 Days 30 Days 75 Days 140 Days
8 Days 40 Days 90 Days 160 Days
15 Days X 45 Days 100 Days 180 Days
20 Days 60 Days 120 Days 190 Days
Automatic Payment Transactions
Payment Methods
In-House Check Letter of Credit Domestic Fund Transfer
Manager's Check Paylink Electronic Fund Transfer

Order Currency PHP USD EUR AUD OTHERS

I certify that the information given in this application is true and correct to the best of my knowledge.

AVELINO M. PINPIN JR. Proprietor/Owner 3-Dec-15

Signature over Printed Name Positon Date