Republic of the Philippines
DEPARTMENT OF TRADE AND INDUSTRY
NATIONAL CAPITAL REGION
Republic of the Philippines
OFFICE OF THE PRESIDENT
HOUSING URBAN AND DEVELOPMENT
COORDINATING COUNCIL
HOUSING AND LAND USE REGULATORY BOARD

APPLICATION FOR LICENSE AND REGISTRATION
(Please submit one copy)

         Application for License and Registration pursuant to Section 3 (e) and (ee) of Act 2728, as amended and Executive Order No. 913, Series of 1983, Executive Order No. 133 and 242 Series of 1987, Presidential Decree No. 957 and other related laws and regulations of the DTI and HLURB.

__________________________________________


1. Name of Applicant :
2. Status : Age :
3. Name of Spouse :
4. Office Address : Tel. No. :
5. Residence :
6. Name of Employee :
7. License No. of Employee :
8. Office Address of Employee : Tel No. :
9. Date and Place of Examination :
10. I have/have not been convicted of any crime involving moral turpitude. If so, state the nature and brief description of case.
       ________________________________________________________________________________
       ________________________________________________________________________________
       ________________________________________________________________________________

 

             I hereby certify that all the foregoing information and data are true and correct to the best of my knowledge and belief and have been given voluntarily without fraudulent or deceitful purpose whatsoever.

         Real Estate Broker's Certification that he is employing applicant when licensed as Real Estate Salesman:

  Signature : _____________________________
  Name in Print :
  REB LIc. No._____ R _______, 20
  PTR No.______ dated_______, 20

____________________________
Applicant

    Name in Print :
    ____________________________________
    TAN : _______________________________
    REBL No. ___________________________

Supporting Papers:
a. [   ] 3 ID Pictures.
b. [   ] Proof of Educational Attainment.
c. [   ] Certificate of Attendance in REB Seminar.
d. [   ] REB Examination Report of Rating.
e. [   ] Clearances from either City or Municipality Clerk of Court, Regional Trial Court or NBI.
f.  [   ] Recommendation of Real Estate Broker.
g. [   ] Cash or Surety Bond (2 copies) _________________________________
          Bond Number : ______________________________________________
          Name of Bonding Company : ___________________________________
h. [   ] Certified copy of Articles of Incorporation or Partnership and Board resolution or Managing Partner's Certificate as to the persons authorized to act for the corporation or partnership in the practice of realty services.