Mezzanine, Grand Riviera Suites

Roxas Blvd. corner Padre Faura St., Ermita, Manila

Contact Nos.: 8521-9927/8247-1878/8208-4611
0977-804-2137 (Globe) / 0925-652-1927 (Sun)
carehealthplus@gmail.com
carehealthplus.com

FRANCHISE LOG IN FORM (FLIF)

Requesting Branch Date of Request
Prospective Account Information

Account Name Line of Business

Other Name / Abbreviation Association

Banking & Finance
Address
Business Process Outsource (BPO)
Contact Person Commercial
Position / Designation Cooperative
Email Industrial
Landline Religious Group
Mobile Medical Field
Enrolment Profile School
Principal Headcount Room & Board Maximum Benefit Limit Union
BODs Others (Please Specify)
Officers Maximum Benefit Limit / Room and Board
Managers 50,000 60,000 ### 80,000
MBL
Supervisors 120,000 100,000 ### 200,000
Rank and File R&B Ward Semi-PrivatePrivate Suite
Dependents HMO Provider
Grand Total Expiry Date
Franchise Status
For Franchise Open Franchise Active Franchise Renewal
Terms of Payment
100% Subsidized Partially Subsidized Voluntary
Please provide your Full Name, Code and Contact Numbers
SC SGM SAM
CODE CODE CODE

Broker's Name, Code and Contact Numbers

General Agency's Name, Code and Contact Numbers
Satellite Office Head's Name, Code and Contact Numbers
I heredy declare and agree that all information above are true and correct. Any misrepresentation on this Franchise Log In Form
will forfeit the ownership of the franchise.

Requested by Endorsed by Approved by

SC/SGM/SAM ABM/BM/AMM/Division Head Maria Inez B. Nicolas

Broker/GA/SOH SAVP-Group Marketing Head

Program Offered Action Taken

GreatValue Program Franchise Number
Paramount Plus Program Approved Date
ValuePlus Program Denied Date
BRANCH FN ORGANIZATION RECEIVED

#NAME? 0 30/12/1899
0
DATE FRANCHISE FN EXPIRATION DAYS LEFT EXTEND DAYS LEFT
PROOF OF EXISTENCE STATUS ADDRESS Contact Person Position For Proposal

0 0 0
0
Contact No. SC Contact No. GM AM

0 0 0 0 0
0
0