GULAY CHIPS RESELLER APPLICATION FORM

Page 1 of 2
INSTRUCTIONS

1 Before filling out, be sure you are of legal age.

2 Accomplish this form in one (1) copy only. This form should be printed in Legal size of paper.
3 This is an uncontrolled copy. Reproduction is accepted. This is absolutely free and downloadable in Gulay Chips website.
4 Submit photocopy or scanned copy of at least one (1) valid ID. Any one of the following:
a. Passport b. GSIS ID c. Driver's License
d. SSS Unified Multi-Purpose ID e. Philippine Identification (PhilID f. PhilHealth ID
(UMID) / ePhilID)
g. Postal ID h. Voter's ID i. Professional Regulation (PRC) ID
j. Barangay ID k. TIN ID l. Student ID
5 Type or print all entries in either CAPITAL or small letters or a combination of Both, as long as eligible.
6 Put NA or N/A if Not Applicable. If filled out online, for the Date portion, make the font color [Black].
7 For ID Number portion, write the number of the photocopied or scanned ID.
8 For Employment History, if had been employed more than thrice, take the three most recent, and arrange them from most recent.
9 Attach a photocopy or scanned copy of ID and proof of address. Use only either black or blue color ballpen or sign pen.
10 For Store Ownership Experience, if had an Store Ownership Experience of more than thrice, take the three most recent,
and arrange them from most recent. In Reason for Closing, just put 'Still Open', if still operating.
11 This can be filled out and signed either digitally or manually. Upload afterwads together with Potocopy or scanned copy of
ID and any proof of address (billing statement of Meralco, PLDT, Globe, Smart, etc., Waterbill, and the likes) to any Gulay
Chips account or as directed.
PERSONAL DETAILS

Name Address

Date of Birth Sex Height Weight

Marital Status Citizenship ID Number Tel./Cell No. Email Address

Estimated Merchandise Amount per Day

Less Than ₱1,ooo More Than ₱1,000 But Less More Than ₱2,000 But Less Than
Than ₱2,000 ₱3,000

More Than ₱3,000 But Less Than More Than ₱4,000 But Less More Than ₱5,000
₱4,000 Than ₱5,000

EMPLOYMENT HISTORY

No. of
No. Company/Address Position Inclusive Years Reason for Leaving
Yrs./Mos.
1

STORE OWNERSHIP EXPERIENCE (Including Present)

No. of Reason for Closing

No. Store Name Address Inclusive Years
Yrs./Mos. (if not anymore operating)
1

3
Gulay Chips Reseller Application Form Page 2 of 2
OTHER BACKGROUND INFORMATION

1 Have you or any applicable partners, officers, directors, or shareholders with your business affiliations ever?

Yes No

2 Had any administrative, criminal or civil action alleging a violation of any franchise law, fraud, embezzlement, fraudulent
conversation, restraint of trade, unfair or deceptive practices, and misappropriation of property or comparable
allegations? Please note that Gulay Chips Company reserves the right to request a copy of your criminal record from the
relevant State Police Authority?

Yes No

3 Been convicted of a felony or pleaded “no contest” to a felony charge or been held liable in a civil action by a final
judgement or been the subject of a material complaint or other legal proceeding such as a felony, civil action complaint,
misappropriation of property or comparable allegations?

Yes No

4 Been adjudged bankrupt or reorganized due to insolvency?

Yes No

5 If you answered “Yes” to any of the questions above, please explain:

GENERAL INQUIRY

1 ARE YOU PREPARE TO COMPLY WITH THE PROCEDURES AND CONTROLS SET BY THE COMPANY?

Yes No

2 Do you intend to work full time in the business?

Yes No

3 Are you aware certain information provided and/or advised to you is confidential and shall not be divulged to any third
person unless the company gives approval?

Yes No

4 Why do you think you will be successful?

CERTIFICATION

I hereby certify that the information given, and all statements made herein are true and correct. Likewise, I hereby authorize
Gulay Chips to collect record, organize, update/modify, consult, use, consolidate, block, erase or destruct my personal data as
part of my information. I hereby affirm my right to: (a) be informed; (b) object to processing; (c) access; (d) rectify, suspend or
withdraw my personal data; (e) damages; and (f) data portability pursuant to the provision of R.A. No. 10173 (Data Privacy Act
of 2012).

Signature Date

FOR GULAY CHIPS USE ONLY

Received by

Signature Over Printed Name Designation Branch/ Unit Date