GS1 Philippines, Inc.

(Formerly Philippine Article Numbering Council, Inc.)

#20 San Rafael St., Bo. Kapitolyo, Pasig City 1603 Tel Nos.: 6370897 to 98, 6370557,6388838, 6330906, 6331589 Fax No: 6314631 Email: pancsrvr@panc.org.ph, Website: www.panc.org.ph

GLOBAL LOCATION NUMBER (GLN) APPLICATION FROM

TYPE OR PRINT IN DARK INK

(Note: Failure to complete the form in FULL and CLEARLY will result in a delay in processing.)

*Required
*Date: ________________ *Company Name: ___________________________________________________________________________ *MailingAddress: __________________________________________________________________________________________ No. Street Town/City Province Zip Code *Website:___________________________________________________________________________________ *Contact Person 1:___________________________________________________________________________ *Position: _____________________________________ E-mail Address: ______________________________ *Tel. No/s.: ____________________________________ Fax No/s.: ___________________________________ *CEO/President/Owner: _______________________________________________________________________
TYPE OF BUSINESS (Check Applicable Box/es) Manufacturer Associations Institution Retailer Supermarket Specialty Store Wholesaler/Distributor/Agent Trader/ Importer / Exporter Vendors Point Of Sale Film Master Label/Tag Scanning/Verification Services Software/ Application Printing/Packaging TYPE OF PRODUCT (Check Applicable Box/es) A. FOOD Baby & Milk Products Beverage Breakfast Foods Cooking & Bakery Prods. Dessert Fruit & Veg. Meat B. HEALTH & BEAUTY AIDS Baby Products Eye & Facial Make-up Feminine/Intimate Hygiene Fragrance Hair Care Nail Care C. NON FOOD: Appliances Animal Products Automotive Baby Needs Books, Magazines & Periodicals Clothing, Footwear, Bags & Accessories Disinfectant Electricals Furniture and Fixtures Hardware Household Needs Calcium Regulating Agent Cardiac Inotropic Agents Chelating Agents, Antidotes and Antagonists Stimulants and Anorectics Corticosteroids Cough Suppressants, Expectorants and Mucolytics Dermatological Agents Disinfectants Diuretics Dopaminergic Antiparkiosnian Agents Xanthines General Anesthetics Histamine H1-Receptor Antagonists Hemostatics Hypothalamic and Pituitary Agents Iodine and lodides Iron and Iron Compounds Lipid Regulating Agents Local Anesthetics Nitrates and Other Anti-angina Agents Nutritional Agents and Vitamins Opioid Analgesics

Pasta, Noodles & Soup Pet/Animal Food Poultry Salad Aid Sea Foods Snack Foods Spreads Oral Hygiene Personal Hygiene Skin care Slimming Other Health and Beauty Aids Horticulture Guns and Ammunitions Musical Instruments School/Office Supplies Sporting Goods Textiles Cigarettes & Tobacco Privilege Cards Multimedia (CD/DVD/Tapes) Medical and Optical Devices Telecommunications

D. PHARMACEUTICAL Analgesics and Anti-inflammatory Agents Antiviral Agents Antihelminthics Anti-Arrhythmic Agents Antibacterial Agents Anticoagulants Antidepressants Antidiabetic Agents Antiepileptics Antifungal Agents Antigout Agents Antihypertensive Agents Antimalarial Agents Antimigraine Agents Antimuscarinic Agents Antineoplastic and Immunosuppresive Antiviral Agents Antiprotozoal Agents Antityphoid Agents Anxiolytic, Sedatives, Hypocotics and Neuroleptics Beta-adrenoceptor Blocking

Radiojpharmaceuticals Sex Hormones Skeletal Muscle Relaxants Stimulants and Anorectics Sympathomimetics Thrombolytic Agents Thyroid Agents Vaccines, Immunoglobulins Vasodilators and Other Agents for Pheripheral and Celebral Vascular Disorders Xanthines General Anesthetics Blood and Blood Products Blood Substitute and Plasma Expanders Parasympathometics Prophylactic Anti-Asthma Agents Prostaglandins

Note: The certificate and all the correspondences will be addressed to Contact Person 1.

*Return this Section to GS1PI (Formerly PANCI).

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*Company Name: _______________________________________________________ *Reason(s) for applying GLN: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

*Trading Partner

*Communication Network Used

*Business Messages used (e.g. P.O., Invoice, etc.)

*EDI Message Standard used: EANCOM Version: __________________ UN/EDIFACT Version: __________________ Other(s) Version: __________________

*Communication Network: Internet E-mail Other *Value Added Network (VAN) E-mail Internet Other Other ___________________

DOCUMENTS TO BE SUBMITTED TO GS1PI (Formerly PANCI): 1. Photocopy of first page of SEC Registration (for Corporation/Partnership/Cooperative) / DTI Registration (for Single Proprietorship). 2. Formal letter stating the companys membership to any association/s (such as Philfoodex, Fil. Chinese Bakery Asso., Fil. Drug Asso., or any other association/s).

***Note: Kindly ask your Trading Partner about the information that you have to fill in this form.

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TERMS AND CONDITIONS In the event of a subscriber not declaring the correct information at the time of application, GS1 Philippines, Inc. (Formerly PANCI) reserves the right to reject/disapprove your application. While the Location Number has been assigned to you, it remains the property of GS1 Philippines, Inc. (Formerly PANCI) and is available only as long as you are using the Location Number according to the rules of GS1 Philippines, Inc. (Formerly PANCI). Should you cease to use the Location Number assigned to you for any reason, your Location Number should be surrendered to GS1 Philippines, Inc. (Formerly PANCI), and may be reallocated. By signing this agreement, you undertake to indemnify GS1 Philippines, Inc. (Formerly PANCI) against all claims and demands (and any expenses thereof) which may be made against GS1 Philippines, Inc. (Formerly PANCI) should you allow your Location Number to be used by any third party of for illegal purposes, or upon terminating your subscription, continue to use the Location Number without the consent of GS1 Philippines, Inc. (Formerly PANCI). Should you wish to re-apply for a Global Location Number, you would be regarded as a new subscriber and will be assigned a different Global Location Number.

LICENSE AGREEMENT 1. We ________________________________ (Company), apply to the GS1 Philippines, Inc. (Formerly Philippine Article Numbering Council, Inc.) for a Location Number. 2. We agree to abide by the rules of GS1 Philippines, Inc. (Formerly PANCI) and terms of the License Agreement which in general requires the license to use the Location Number given; not to permit its use to any other person or organization; to use only the 13-digit Location Number issued by GS1 Philippines, Inc. (Formerly PANCI). 3. We acknowledge that if we fail to observe the GS1 Philippines, Inc. (Formerly PANCI) rule, or any term of the license, the license may be terminated. 4. We further acknowledge and agree that our right to use the Location Number ceases immediately upon termination of our Subscription together with this licensing agreement, or if we otherwise infringe the intellectual property or other rights of GS1 Philippines, Inc. (Formerly PANCI), we will be liable to GS1 Philippines, Inc. (Formerly PANCI) for any loss or damage to it as a result. 5. Notwithstanding any termination of the License or our License Subscription by GS1 Philippines, Inc. (Formerly PANCI), we agree that the provisions of paragraph four (4) above will continue to be in full force and will be binding on us.
________________________________ Printed Name of Company ________________________________ *Printed Name of CEO/Pres./Owner ________________________________ *Signature of CEO/Pres./Owner ________________________________ *Date Signed Signed in the Presence of :

_______________________________ (*Print Name & Signature of Witness) _______________________________ (Print Name & Signature of Witness)

There MUST be at least one witness printed name & signature

Return this Section to GS1PI (Formerly PANCI).

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***Format Only***
***NOTE: Please follow the format EXACTLY to avoid delays.

(ASSOCIATIONS LETTER HEAD)

CERTIFICATION

This is to certify that ________________________________________ member of __________________________________________ ___________________________(years). This also further certifies that we to apply

(company name) is a name) since

(association

are for

allowing

________________________________________(company name)

Global Location

Number to GS1 Philippines, Inc. (Formerly Philippine Article Numbering Council, Inc.) as a separate entity / independent company. Signed this ____ day of ________________, year _______.

___________________________ Print name & Signature of Authorized Person from the Association __________________________ Designation of Authorized Person from the Association

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***Format Only***

(COMPANYS LETTER HEAD)

CERTIFICATION

This is to certify that ________________________________________ (company name) is not a member of any Industry Association/s in the Philippines or in abroad.

This certification is issued for the purpose of applying for Global Location Number with GS1

Philippines, Inc. (Formerly Philippine Article Numbering Council, Inc.)

Signed this ____ day of ________________, year _______.

___________________________ Print name & Sign of PRESIDENT/CEO/OWNER

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