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CLIENT PROFILE REGISTRATION FORM (IMPORTER)

INSTRUCTION: Please provide the following required information according to your client type by filling out
tablecells or ticking off appropriate boxes in the 2nd column. Mandatory fields are written in bold type and
markedwith asterisks ( * ). Items in the 2nd column with asterisks ( * ) and not in bold type are the optional but
become mandatory when one of them in the same optional group is being filled out. Figures in parenthesis
indicate the exact/maximum number of characters allowed for the corresponding field.

1. CLIENT TYPE *

Importer

2. NATURE OF BUSINESS *

Other Wholesaling

3. BUSINESS ENTITY *

Corporation

4. BUSINESS NAME * (35)

BANDALLE MARINE SUPPLY & SERVICES

5. CITIZENSHIP * (17)

PHILIPPINES

6. BUSINESS ADDRESS

ADDRESS * (70)

CORPORATION / OUANO BLDG PUROK NARRA DURBAN COUNTRYSIDE


TAYUD LILOAN

CITY * (20)

LILOAN, CEBU

ZIP CODE* (9)

6002

COUNTRY * (2)

PHILIPPINES

PHONE * (7-15)

0324241019

7. CONTACT INFORMATION *

ALTERNATE
PHONE (7-15)
FAX (7-15)
MOBILE PHONE *
(10-15)
EMAIL * (88)

bandallemarine_corporation@yahoo.com

WEBSITE/URL(100)
8. WAREHOUSE/TRANSIT CODE *
9. TAX IDENTIFICATION NO. * (12)

467135624000

10. SOCIAL SECURITY NO. * (12)


11. PASSPORT NO. (17)
12. DRIVER'S LICENSE NO. (17)
13. PRC ID NO. (17)
14. PRIMARY VASP CCN NO. * (12)

VA0000000078

15. SECONDARY VASP CCN NO. (12)


16. PEZA-BOI Registration No. (if applicable) /
CARR Code (2-17)
17. SEC REGISTRATION NO. / DTI Ref
No. *

CS201533345

18. AMOUNT OF AUTHORIZED


CAPITAL STOCK * (16)

5,000,000.00

19. AMOUNT OF PAID-UP


CAPITAL * (16)

500,000.00

RELATED DOMESTIC AND


0
FOREIGN COMPANY

RELATED COMPANY
(100)
COMPANY TYPE

BROKER 1

PLANT ADDRESS

TIN * (12)

936227663000

CCN * (12)

BR0000717193

ADDRESS * (35)

OUANO BLDG. TAYUD LILOAN CEBU

CITY * (25)

LILOAN, CEBU

ZIP CODE * (9)

6002

COUNTRY * (2)

PHILIPPINES

CLIENT PROFILE REGISTRATION FORM (IMPORTER) - BANDALLE MARINE SUPPLY & SERVICES

MAJOR STOCKHOLDER
MAJOR
STOCKHOLDER

FIRST NAME * (35)

BRIAN

MIDDLE NAME *

ROMO

LAST NAME *

BANDOJA

CITIZENSHIP *

PHILIPPINES

TIN/ PASSPORT NO./ or


ACR NO. (12)

256141262000

ADDRESS * (35)

STO. TOMAS VILLAGE TUBURAN SUR

CITY * (25)

DANAO CITY

ZIP CODE * (9)

6004

COUNTRY * (2)

PHILIPPINES

PHONE * (7-15)

09177194483

ALTERNATE PHONE (715)


MOBILE (10-15)
FAX (7-15)
EMAIL * (88)

brian.bandoja@gmail.com

SIGNATURE

PRINCIPAL OFFICER

FIRST NAME * (35)

FELIXBERTO JR

MIDDLE NAME *

OLIMBA

LAST NAME * (35)

ABALLE

POSITION * (35)

VICE PRESIDENT

TIN/ PASSPORT
NO./ or ACR NO.

139691333000

ADDRESS * (35)

BAJADA POBLACION

CITY * (25)

SAN REMEGIO

ZIP CODE * (9)

6011

COUNTRY * (2)

PHILIPPINES

PHONE * (7-15)

0324359115

ALTERNATE
PHONE (7-15)
MOBILE (10-15)
FAX (7-15)
EMAIL * (88)

aballejun@hotmail.com

SIGNATURE

CLIENT PROFILE REGISTRATION FORM (IMPORTER) - BANDALLE MARINE SUPPLY & SERVICES

RESPONSIBLE OFFICER

FIRST NAME * (35)

LENGIE

MIDDLE NAME *

VILLAMOR

LAST NAME *

BANDOJA

POSITION * (35)

OFFICE HEAD

TIN/ PASSPORT NO./ or


ACR NO. (12)

261353035000

AREA OF
RESPONSIBILITY * (35)

ADMINISTRATION FINANCE

ADDRESS * (35)

STO. TOMAS VILLAGE TUBURAN SUR

CITY * (25)

DANAO CITY

ZIP CODE * (9)

6004

COUNTRY * (2)

PHILIPPINES

PHONE * (7-15)

0324241019

ALTERNATE PHONE (715)


MOBILE (10-15)
FAX (7-15)
EMAIL * (88)

levie_0712@yahoo.com

SIGNATURE

MAJOR SUPPLIER

TIN / PASSPORT No. /


or ACR NO. (12)

000000000000

NAME * (35)

ZHEJIANG HAIJIMARINE ELECTRIC CO LT

ADDRESS *

NO 503 LEHU ROAD SHAHU INDUSTRIAL

CITY * (25)

ZONE LIUSHI ZHEJIANG

ZIP CODE * (9)

325604

COUNTRY * (2)

CN

PHONE * (7-15)

86057762739265

ALTERNATE PHONE (715)


FAX (7-15)
MOBILE (10-15)
EMAIL * (88)

IMPORTABLE COMMODITY

zjhaiji@163.com

COMMODITY CODE
ITEM NAME
COMMODITY
DESCRIPTION

CLIENT PROFILE REGISTRATION FORM (IMPORTER) - BANDALLE MARINE SUPPLY & SERVICES

CERTIFICATION

I certify that the foregoing information are true and correct to the best of my knowledge.

(Signature over Printed Name)

Date Signed:

CLIENT PROFILE REGISTRATION FORM (IMPORTER) - BANDALLE MARINE SUPPLY & SERVICES

REPUBLIC OF THE PHILIPPINES)


CITY OF MANILA
)S.S
Before me, a Notary Public for and in the City of Manila this ____ day of _______,2015 personally appeared
the following:

NAME

COMMUNITY TAX CERT. NO.

DATE/PLACE ISSUED

known to me to be the same persons who executed the foregoing instrument and they acknowledged to
me that the same are their free and voluntary acts and deeds.
This client profile registration form consisting of 5
pages, including the page on which this
acknowledgement is written and the Nature of Business attachment of _____ pages, has been signed
on the left margin each and every page and at the bottom of this instrument the parties and their
respective witnessess.
WITNESS MY HAND AND NOTARIAL SEAL ON THE DAY, YEAR AND PLACE ABOVE-WRITTEN

Doc. No._______________;
Page No.______________;
Book No.______________;
Series of 2015