.- - ANNEX 8~ . ,

(BOC-USE ONLY:

-Date Rec'd: I /By:Update No.

Time:

BUREAU OF CUSTOMS

Super Gre~n LaneCHANGE REQUEST FORM

i' ,-.

,/, : .,,-

Date:

The Bureau of CuStOlllSSGL Conunittee

Gentlemen:

We would like to file this application for change/s to our SGL data in the area(s)specified belo\v:

1.1. CHANGE IN CORPORATE NAME OF IMPORTER TO

1.3. CHANGE IN ADDRESS/CONTACT DETAILS:

Office

Plant

Tel. No. Fax No.

- 1

,! 1.5.- CHANGE IN NATURE OF BUSINESS:

D Manufacturer D Service Provider

0 Trader 0 Public Utility

0 Others (please specify)

"

1.6. CHANGE IN TYPE OF BUSINESS ENTITY:

D Single Proprietorship

D Partnership

0 Corporation VPage I of 4

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1.7. 'CHANGES IN CAPI! AL STRUCTURE

A. Major Stockholders

Please use additional sheets as necessalY. For additional sheets, please mark it as'ANNEX I.A - MAJOR STOCKHOLDERS'.

B. Change in Principal Officers

Please use additional sheets as necessary. For additional sheets, please mark it as'ANNEX I.B - PRINCIPAL OFFICERS'.

1.8. Changes in names and addresses of any foreign and/or domestic related companies,such as company's parent, sister, subsidiaries,joint ventures, etc:

Please use additional sheets as necessalY. For additional sheets, please mark it as

'ANNEX 2 - RELATED CaMP ANIES'V

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4

rage 2 of 4

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1 CITIZENNAME OF STOCKHOLDER

NO. SHARES NO. SHARES VALUE SHARES'SHIP SUBSCRIBED PAID-UP PAID-UP (PhP)

,

NAME OF OFFICER POSITION

COMPANY NAME ADDRESS

,

Cban!!es in Customs Broker Information (Supercedes previous submittedJiilll

Please use additional sheets as necessary. For additional sheets, please mark it as'ANNEX 3 - CUSTOMS BROKER INFORMATION'.

Cbao!!es in List of Suppliers and Imported Commodities: (Supercedes previoussubmitted list}

Please use additional sheets as necessary. For additional sheets, please mark it as'ANNEX4- SUPPLIERS'. .

Cban!!es in List of Commodities loworted.(List only the additions/cban!!es and/ordeletions

Note to SGL Member Use theformat of 'ANNEX5- LIST OF COMMODITIESIMPORTED'. INDICATEADDITIONALITEMSFIRSTFOLLOWEDBY ITEMSFORDELETION.

(pr-

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Page 3 of 4

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BROKERAGE NAME ADDRESS & PHONE CONTACT PERSON PORTS OF NO. OF YEARS ASNO. ENTRY YOUR BROKER

I.

2.

3.j

SUPPLIER NAME ADDRESS I PHONE CONTAcr COMMODITIESPERSON mpPLlED

I

2

3

4

5

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. CERTIFICATION-------------

Tlus is to certii)r that the undersigned has read Executive Order No. 230, CustomsAdministrative Order No. 2-2000, Customs Administrative Order 5-2001, Custon1SMemorandum Order No. 2-2000, Customs Memorandum Order 2-2002, and other relatedrules and regulations implementing them.

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It is further certified that all information contained in tillSChange Request Fonnare true and correct.

Done in the cityl111unicipalityof tills day of

Signature over name of President/Proprietor

Name of Company:

SUBSCRIBED AND SWORN to before Ine tIus day of ,200- in the City/Municipality of . Affiant exlubited to Ine Ius/herCommuntiyTax CertificateNo. . issued in on

Notary Public

Doc. No.

Page No.Book No.

S~ries 0f ~

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