NDMF 961DN COMPANY DATA MAINTENANCE FORM

GENERAL/BUSINESS/COMPANY RELATIONSHIPINFORMATION
(FOR DOMESTIC COMPANIES ONLY)

SEC NUMBER /D/S/-/0/4/3/8/7/ FOR SEC TO PROVIDE: MAINTENANCE NO.: / _/__/__/__/__/__/__/ TRANSACTION DATE / /_/_/_/_/_/_/_/_/_/
FILL UP INSTRUCTIONS: Type or print legibly. Light shaded boxes are to be filled up by the SEC. Check appropriate boxes.
FILL UP ONLY THOSE ITEMS FOR WHICH AMENDMENTS OR CHANGES ARE TO BE MADE. Refer to the back page for additional instructions.
CURRENT COMPANY NAME
THELSAN
RESERVATION NUMBER: NEW COMPANY NAME RESTRICT USED BY OTHERS?
[ ] YES [ ] NO

GENERAL INFORMATION
COMPANY [ ] DS-DOMESTIC [ /] DN-DOMESTIC NON- [ ] DS-DOMESTIC CHANGES FROM STOCK TO NON-STOCK? CHANGE IN PRIMARY
TYPE STOCK STOCK PARTNERSHIP [ ] YES PURPOSE [ ] YES
PRINCIPAL OFFICE ADDRESS
NUESTRA SRA. DELA PAZ STREET, GENERAL SANTOS CITY
AREA CODE POSTAL CODE TEL. NO FAX NO.
/9/5/0/0/ 554-6323 554-6323
PRINCIPAL OFFICE ADDRESS
NUESTRA SRA. DELA PAZ STREET, GENERAL SANTOS CITY
AREA CODE POSTAL CODE TEL. NO FAX NO.
/9/5/0/0/ 554-6323 554-6323
BUSINESS INFORMATION
PARTNERSHIP TYPE TYPE OF ENTERPRISE [/] N-NO SPECIAL REGISTRATION [ ] H-FIA HOLDING [ ] F-FINANCIAL INSTITUTION
[ ] L-LIMITED [ ] E-FIA EXPORT [ ] R-FIA REPRESENTATIVE OFF. [ ] Z-EPZA-REGISTERED
[ ] G-GENERAL [ ]-FIA DOMESTIC [ ] S-SUBIC REGISTERED [ ] B-BOI-REGISTERED
INDUSTRY CODE TERM OF EXISTENCE END DATE OF EXISTENCE FISCAL YEAR END (MM/DD) ANNUAL MEETING (For domestic companies only)
50 YEARS 04-06-2055 05-31 [ ] F-FIXED (MM/DD) /_/_/ [ ] V-VARIABLE: last Sunday of August
NUMBER OF DIRECTORS (If stock co.) TRUSTEES (If non-stock co.) 10 PARTNERS (If partnership) STOCKHOLDERS (If stock co.)
TYPE OF NON-STOCK TOTAL CONTRIBUTION (Of non-stock % OF FOREIGN MEMBERSHIP (Of non-stock companies) TOTAL CONTRIBUTION (Of domestic partnership)
CORPORATION (Refer to the companies) Filipino: Foreign:
back page for the classification) P 1,000,000.00
COMPANY RELATIONSHIP –List all companies related to registrant. (Use additional sheets, if necessary.)
RELATIONSHIP TYPE M-DISSOLVED COMPANY (If due to merger) S-PARENT COMPANY (If registered is a subsidiary) O- OTHERS
(REL’N TYPE) V-DISSOLVED COMPANY (If change in company type A-AFFILIATE (Of registrant) ___________________________
MAIN IND RELN TYPE SEC NUMBER COMPANY NAME START DATE END DATE
__________ ___________ __________ _________________________________________ _______________________ _____________________
_ ___________ __________ _________________________________________ _______________________ _____________________
__________
_

MAIN IND – A (NEW), E (UPDATE EXISTING), OR D (DELETE) RELATIONSHIP INDICATE START (If NEW) OR END DATE OF RELATIOSHIP

CERTIFIED CORRECT BY: AMOR IRISH D. LOZANO POSITION: CORPORATE SECRETARY DATE: ________________
(Signature over printed name)
PROCESSING ATTORNEY: DATA CONTROL CLERK: DATA ENCODED BY:

DATE REVIEWED: DATE REVIEWED: DATE REVIEWED: