International Marketing Partner Accreditation Form: Personal Background
International Marketing Partner Accreditation Form: Personal Background
International Marketing Partner Accreditation Form: Personal Background
Telephone Nos. (632) 631 - 1231 to 38 Fax No. (032) 631 – 6517
PERMANENT/MAILING ADDRESS
PROFESSIONAL DATA
TYPE OF ACCREDITATION: Individual Broker Mar keting Partner (Local)
(please check) Broker Company Marketing Partner (International)
BROKER/COMPANY NAME (IF APPLICABLE) BUSINESS ADDRESS
BROKER’S/SALESMAN’S LICENSE NO. AND EXPIRY DATE SEC REGISTRATION NO. (FOR BROKER COMPANY ONLY) VAT NUMBER
SOCIAL SECURITY (SSS) NO. TAX IDENTIFICATION (TIN) NO. BROKER ORGANIZATION AFFILIATION
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REMITTANCE INSTRUCTION
FOR INTERNATIONAL MARKETING PARTNER
NAME OF IMP:
Attach copy of PASSPORT for verification.
Account Number:
Bank Name:
Bank Address:
SWIFT Code:
ABA Routing:
I hereby authorize Ortigas and Company, Limited Partnership, its subsidiaries, affiliates,
partners, successors and/or assigns (the “Ortigas Group”) to collect, process, store, and use
any and all information that I furnish the Ortigas Group for the purpose of processing any
commission and marketing fees that may be due to me. I hereby expressly and knowingly
waive any and all statutory or regulatory provisions governing the confidentiality of such
information, if applicable.
IMP's Signature:
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