securities and exchange...

111192013002485

SECURITIES AND EXCHANGE COMMISSIONSECBuilding,EDSA,Greenhills,MandaluyongCity,MetroManila,Philippines

Tel:(632)726-0931to39Fax:(632)725-5293Email:[email protected]

Barcode PageThe following document has been received:

Receiving Officer/Encoder : Fernando T. Fernandez

Receiving Branch : SEC Head Office

Receipt Date and Time : November 19, 2013 03:37:59 PM

Received From : Head Office

Company Representative

Doc Source

Company Information

SEC Registration No.

Company Name

Industry Classification

Company Type

Document Information

PW00000727

CENTRAL AZUCARERA DE TARLAC

Stock Corporation

Document ID

Document Type

Document Code

Period Covered

No. of Days Late

Department

Remarks

111192013002485GENERAL INFORMATION SHEET

GIS

October 29, 2013

0

CED/CFD/CRMD/MRD

Amendment

GENERAL INFORMATION SHEET (GIS)

FOR THE YEAR 2013 (Amended) -

STOCK CORPORATIONGENERAL INSTRUCTIONS:FOR USER CORPORATION: THIS GIS SHOULD BE SUBMITTED WITHIN THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE ANNUASTOCKHOLDERS' MEETING. DO NOT LEAVE ANY ITEM BLANK. WRITE "N.A." IF THE INFORMATION REQUIRED IS NOT APPLICABLE TO TH

ORPORATION OR "NONE" IF THE INFORMATION IS NON-EXISTENT.r2. IF NO MEETING IS HELD, THE CORPORATION SHALL SUBMIT THE GIS TOGETHER WITH AN AFFIDAVIT OF NON-HOLDING OF MEETING WITHI

THIRTY (30) CALENDAR DAYS FROM THE DATE OF THE SCHEDULED ANNUAL MEETING (AS PROVIDED IN THE BY-LAWS). HOWEVER, SHOULD3. THIS GIS SHALL BE ACCOMPLISHED IN ENGLISH AND CERTIFIED AND SWORN TO BY THE CORPORATE SECRETARY OF THE CORPORATION4. THE SEC SHOULD BE TIMELY APPRISED OF RELEVANT CHANGES IN THE SUBMITTED INFORMATION AS THEY ARISE. FOR CHANGE:

RESULTING FROM ACTIONS THAT AROSE BETWEEN THE ANNUAL MEETINGS, THE CORPORATION SHALL SUBMIT ONLY THE AFFECTED PAGIOF THE GIS THAT RELATES TO THE NEW INFORMATION TOGETHER WITH A COVER LETTER SIGNED BY THE CORPORATE SECRETARY OF THICORPORATION. THE PAGE OF THE GIS AND COVER LETTER SHALL BE SUBMITTED WITHIN SEVEN (7) DAYS AFTER SUCH CHANGIOCCURRED OR BECAME EFFECTIVE.

5. SUBMIT FIVE (5) COPIES OF THE GIS TO THE CENTRAL RECEIVING SECTION, GROUND FLOOR, SEC BLDG., EDSA, MANDALUYONG CITY. ALCOPIES SHALL UNIFORMLY BE ON A4 OR LETTER-SIZED PAPER WITH A STANDARD COVER PAGE. THE PAGES OF ALL COPIES SHALL USEiONLY ONE SIDE. CORPORATIONS SUBMITTING A COPY OF THEIR GIS ONLINE OR VIA INTERNET SHALL SUBMIT ONE (1) HARD COPY OF THEGIS, TOGETHER WITH A CERTIFICATION UNDER OATH BY ITS CORPORATE SECRETARY THAT THE COPY SUBMITTED ONLINE CONTAINS THEIEXACT DATA IN THE HARD COPY.

7. THIS GIS MAY BE USED AS EVIDENCE AGAINST THE CORPORATION AND ITS RESPONSIBLE DIRECTORS/OFFICERS FOR ANY VIOLATION OEXISTING LAWS, RULES AND REGULATIONS

PLEASE PRINT LEGIBLY >

IORPORATE NAME:CENTRAL AZUCARERA DE TARLAC

BUSINESS/TRADE NAME: CAT

SEC REGISTRATION NUMBER: 727

DATE REGISTERED:

June 19,1927

FISCAL YEAR: 30 June

DATE OF ANNUAL MEETING PER BY-LAWS:

LAST TUESDAY OF JANUARY

CORPORATE TAXIDENTIFICATION NO (TIN)000-229-931

ACTUAL DATE OF ANNUAL MEETING: October 29, 2013 WEBSITE/URL ADDRESS:none

COMPLETE PRINCIPAL OFFICE ADDRESS:

San Miguel Tarlac City

:OMPLETE BUSINESS ADDRESS:

MAKATI OFFICE, 119 DELA ROSA ST., LEGASPI VILLAGE/ SAN MIGUEL, TARLAC CITYFAX* 817-9309

NAME OF EXTERNAL AUDITOR & ITS SIGNING PARTNER:iGV&Co. / MR. ARNEL DE JESUS

SEC ACCREDITATION NUMBER (ifapplicable):

TELEPHONE NUMBER(S):

818-3911

RIMARY PURPOSE/ACTIVITY/INDUSTRY PRESENTLY ENGAGED IN:

MANUFACTURE OF SUGAR & BY - PRODUCTS

INDUSTRY CLASSIFICATION:

FOOD BEVERAGE

GEOGRAPHICAL CODE:

n/a

======= INTERCOMPANY AFFILIATIONS ======= ========

PARENT COMPANY SEC REGISTRATION NO. ADDRESSN/A N/A

SUBSIDIARY/AFFILIATE SEC REGISTRATION NO. ADDRESS

N/A N/A N/A

NOTE: USE ADDITIONAL SHEET IF NECESSARY

GIS_STOCK(v.2013) Pagel

GENERAL INFORMATION SMtt 1

STOCK CORPORATIONrLtAot rKIIM 1 Lt^jIbL Y

Corporate Name:

A. Is the Corporation a covered person under the Anti Money Laundering ., r— - i .. pr~ 1iP**^ 1 i No 1 •"- 1

Act(AMLA), as amended? (Rep. Acts. 9160/9164/10167/10365) 1 — 1 ' 'Please check the appropriate box:

1.t--ia. Banks^-jb. Offshore Banking Unitsr~1c. Quasi-Banksr—"id. Trust Entitiesf~~le. Non-Stock Savings and Loan Associationsr— i f. Pawnshops(— jg. Foreign Exchage Dealersr—1h. Moneychangersp-l i. Remittance Agentsr— i j. Electronic Money Issuersr- — } k. Financial Institutions which Under Special Laws are subject to

Bangko Sentral ng Pilipinas' (BSP) supervision and/orregulation, including their subsidiaries and affiliates.

2.r— ' la. Insurance Companiesi-j-ib. Insurance Agentsr;i=t c. Insurance Brokersr^d. Professional Reinsurersr-r-ie. Reinsurance Brokerst^J f. Holding Companiesj— jg. Holding Company Systemsd]h. Pre-need Companiesr— i j. Mutual Benefit AssociationIT! j. All Other Persons and entities supervised and/or regulated by

j the Insurance Commission (1C)

3. :

r— -ia. Securities DealersCT3 b. Securities BrokersC— 3 c. Securities Salesmanr— |d. Investment Housesp— fe. Investment Agents and Consultants,— , f. Trading Advisorspn g. Other entities managing Securities or rendering similar services|— "1 h. Mutual Funds or Open-end Investment CompaniesF— | i. Close-end Investment CompaniesfTI j. Common Trust Funds or Issuers and other similar entitiesr— i k. Transfer Companies and other similar entitiesr—i 1. Other entities administering or otherwise dealing in currency,

commodities or financial derivatives based there onC331 m. Entities administering of otherwise dealing in valuable objectsdpi n. Entities administering or otherwise dealing in cash Substitutes

and other similar monetary instruments or property supervisedand/or regulated by the Securities and Exchange Commission(SEC)

__, Jewelry dealers in precious metals, who, as a' '"*"' business, trade in precious metals

__ Jewelry dealers in precious stones, who, as abusiness, trade in precious stone

Company service providers which, as a business,6. provide any of the following services to third

parties:

r— ia. acting as a formation agent of juridical personsr— jb. acting as (or arranging for another person to act

as) a director or corporate secretary of a company,a partner of a partnership, or a similar position inrelation to other juridical persons

CZJc. providing a registered office, business address oraccommodation, correspondence or administrativeaddress for a company, a partnership or any otherlegal person or arrangement

r— - »d. acting as (or arranging for another person to actas) a nominee shareholder for another person

7. Persons who provide any of the following services:I"— la. managing of client money, securities or other

assets

f--|b. management of bank, savings or securitiesaccounts

i— ic. organization of contributions for the creation,operation or management of companies

r— id. creation, operation or management of juridicalpersons or arrangements, and buying and sellingbusiness entities

8. SSI None of the above

Describe nature of business: Manufacturre ofSugar and By-Products

B. Has the Corporation complied with the requirements on Customer DueDiligence (CDD) or Know Your Customer (KYC), record-keeping, and Yes [""""] No ["""Isubmission of reports under the AMLA, as amended, since the last filing of its

;iS_STOCK(v.2013) 1-A

GENERAL INFORMATION SHEETSTOCK CORPORATION

========== PLEASE PRINT LEGIBLY =========

CORPORATE NAME: CENTRAL AZUCARERA DE TARLAC

CAPITAL STRUCTURE

AUTHORIZED CAPITAL STOCK

TYPE OF SHARES *

common

NUMBER OFSHARES

40,000,000.00

PAR/STATED VALUE

10.00

TOTAL 40,000,000.00 TOTAL P

AMOUNT (PhP)(No. of shares X Par/Stated Value)

400,000,000.00

400,000,000.00SUBSCRIBED CAPITAL

F I L I P I N O

i

NO. OFSTOCK-

HOLDERS

560

TYPE OF SHARES *

common

NUMBER OFSHARES

27,635,274

TOTAL 27,635,274

F O R E I G N(INDICATE BYNATIONALITY)

NO. OFSTOCK-

HOLDERS

81

TYPE OF SHARES *NUMBER OF

SHARES

618,602

Percentage of Foreign Equity : TOTAL 618,602

NUMBER OFSHARES INTHE HANDS

OF THEPUBLIC **

TOTALNUMBER OFSHARES INTHE HANDS

OF THEPUBLIC **

TOTAL

PAR/STATEDVALUE

10.00

TOTAL P

PAR/STATEDVALUE

10.00

TOTAL PTOTAL SUBSCRIBED P

AMOUNT (PhP)

276,352,740.00

276,352,740.00

AMOUNT (PhP)

6,186,020.00

6,186,020.00282,538,760.00

%OFOWNERSHIP

0.97

%OFOWNERSHIP

0.03

PAID-UP CAPITAL

F I L I P I N ONO. OFSTOCK-

HOLDERS

560

TYPE OF SHARES *

common

TOTAL

F O R E I G N(INDICATE BYNATIONALITY)

I— I

NO. OFSTOCK-

HOLDERS

81

TYPE OF SHARES *

NUMBER OFSHARES

27,635,274

27,635,274

NUMBER OFSHARES

618,602

2.19% TOTAL 618,602

PAR/STATED VALUE

10.00

TOTAL P

PAR/STATED VALUE

TOTAL PTOTAL PAID-UP P

AMOUNT (PhP)

276,352,740.00

276,352,740.00

AMOUNT (PhP)

6,186,020.00

6,186,020.00282,538,760.00

%OFOWNERSHIP

0.97

%OFOWNERSHIP

0.03

NOTE: USE ADDITIONAL SHEET IF NECESSARYCpmmon, Preferred or other classificationOther than Directors, Officers, Shareholders owning 10% of outstanding shares.

GIS STOCKfv.2013)


================================ PLEASE PRINT LEGIBLY ==================


D I R E C T O R S / O F F I C E R S

NAME, NATIONALITY ANDCURRENT RESIDENTIAL ADDRESS

1. J,OSE COJUANGCO JR.1£26 Acacia Road, Dasmarinas Village,lyiakati City

2. ERNESTO G. TEOPACO3 Joaquin cor. Luna St., Corinthian Garden,Quezon City

3. MARIE THERESE R. MCMURRAY557 Wack Wack Road Mandaluyong City

4. JpSE MANUEL C. LOPA49 Bacolod St., Alabang Hills SubdivisionMuntinlupa City

5. FERNANDO C. COJUANGCO212 Cuenca St., Ayala Alabang, MuntinlupaCity

6, KRISTINA BERNADETTE C. AQUINORoxas Triangle, Paseo de Roxas, Makati City

7. RENATO B. PADILLA46 Mactan St., Ayala Heights Subdivision, OldBalara, Quezon City

8. BENJAMIN I. ESPIRITU6 Fernsville, St., White Plains, Quezon City

9. MARIA CECIILIAT. SANTOS3 Joaquin cor. Luna St., Corinthian Garden,Quezon City

10 ADDISON B. CASTROUnit 400 Pearl Bldg., Rosewood PointeResidences, Acacia Estates, Taguig City

11,

12.

13.

INC'R

N

N

N

N

N

N

N

N

N

IT

BOARD

C

M

M

M

M

M

I

I

SEX

M

M

F

M

M

F

M

M

F

M

STOCKHOLDER

Y

Y

Y

Y

Y

Y

Y

Y

-rr

iff

OFFICER

President

VicePresident

VicePresident

N/A

VP&ChiefOperating

N/A

N/A

N/A

Tresurer

CorporateSecretary

EXEC.COMM.

C

N

C

A

A

N

C

N

A

TAX IDENTIFICATION NO.(TIN) FOR FILIPINOS AND

FOREIGNERS

105-548-046

104-175-118

104-175-342

120-087-341

104-174-957

101-717-443

129-425-833

106-392-124

104-240-987

104-447-295

INSTRUCTIONS:

FOR SEX COLUMN, PUT "F" FOR FEMALE, "M" FOR MALE.I FOR BOARD COLUMN, PUT "C" FOR CHAIRMAN, "M" FOR MEMBER, "I" FOR INDEPENDENT DIRECTOR.! FOR INC'R COLUMN, PUT "Y" IF AN INCORPORATOR, "N" IF NOT.

FOR STOCKHOLDER COLUMN, PUT "Y" IF A STOCKHOLDER, "N" IF NOT.FOR OFFICER COLUMN, INDICATE PARTICULAR POSITION IF AN OFFICER, FROM VP UP INCLUDING THE POSITION OF THE TREASURER,

SECRETARY, COMPLIANCE OFFICER AND/OR ASSOCIATED PERSON.FOR EXECUTIVE COMMITTEE, INDICATE "C" IF MEMBER OF THE COMPENSATION COMMITTEE; "A" FOR AUDIT COMMITTEE; "N" FOR NOMINATION

AND ELECTION COMMITTEE. ADDITIONALLY WRITE "C" AFTER SLASH IF CHAIRMAN AND "M" IF MEMBER.

GIS_STOCK(v.2013) Pages


================================ PLEASE PRINT LEGIBLY ================================


"OTAL NUMBER OF STOCKHOLDERS: NO. OF STOCKHOLDERS WITH 100 OR MORE SHARES EACH:

"OTAL ASSETS BASED ON LATEST UNAUDITED FINANCIAL STATEMENTS:

STOCKHOLDER'S INFORMATION

NAME, NATIONALITY AND

CURRENT RESIDENTIAL ADDRESS

1. Jose Cojuangco & Sons, Inc.

JCS Bldg., 119 Dela Rosa St., Legaspi VillageMakati City

2. Luisita Trust Fund

JCS Bldg., 119 Dela Rosa St., Legaspi VillageMakati City

3. PCD Nominee Corp. ( Filipino )

37 Fir., Tower 1 Enterprise Center, Ayala AvenueMakati City

I

4. Tarlac Distillery Corporation

JCS Bldg., 119 Dela Rosa St., Legaspi Village,Makati City

5. Luisita Marketing Corporation


6. Pedro S. Cojuangco


7. Enrique Robert C. Reyes

557 Wackwack Road, Mandaluyong City

SHARES SUBSCRIBED

TYPE

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

NUMBER

7,855,828

7,855,828

4,734,492

4,734,492

1,894,476

1,894,476

1,586,328

1,586,328

1,291,052

1,291,052

408,690

408,690

375,600

375,600

TOTAL AMOUNT OF SUBSCRIBED CAPITAL

AMOUNT

(PhP)

7,855,828.00

4,734,492.00

1,894,476.00

1,586,328.00

1,291,052.00

408,690.00

375,600.00

%OFOWNER-

SHIP

0.27

0.17

0.06

0.05

0.04

0.01

0.01

TOTAL AMOUNT OF PAID-UP CAPITAL

AMOUNT PAID(PhP)

78,558,280.00

47,344,920.00

18,944,760.00

15,863,280.00

12,910,520.00

4,086,900.00

3,756,000.00

TAX IDENTIFICATION NO.(TIN) FOR FILIPINOS or

PASSPORT NO. FORFOREIGNERS

000-127-289

000-472-568

000-774-849-OOONV

000-229-663

000-129-426

100-304-671

|

124-140-734

INSTRUCTION: SPECIFY THE TOP 20 STOCKHOLDERS AND INDICATE THE REST AS OTHERS

lote: For PDTC Nominee included in the list, please indicate further the beneficial owners owning more than 5% of any class of the company's voting securities.\ttach separate sheet, if necessary.

GIS_STOCK(v.2013) Page 4


========================= PLEASE PRINT LEGIBLY ==-===============================


TOTAL NUMBER OF STOCKHOLDERS: NO. OF STOCKHOLDERS WITH 100 OR MORE SHARES EACH:

TOTAL ASSETS BASED ON LATEST UNAUDITED FS: Php2,842,431, 329.00



|

8. Marie Therese C. Reyes


9. Nicanor C. Reyes III


•

10. Joaquin Jose C. Reyes

557 yVackwack Road, Mandaluyong City

11. PazC. Teopaco

Luna, cor. Joaquin St., Corinthian Garden, QuezonCity

12. Rosario C. Cojuangco

1575, Princeton St., Mandaluyong City

13. Ernesto G. Teopaco

Luna, cor. Joaquin St., Corinthian Garden, QuezonCity

14. VictoVia Elisa C. Aquino

18 Kingfishers St., Greenmeadows, Quezon City

SHARES SUBSCRIBED

TYPE

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

NUMBER

370,000

370,000

368,360

368,360

365,360

365,360

323,136

323,136

316,434

316,434

302,464

316,434

298,616

298,616


AMOUNT(PHP)

370,000.00

368,360.00

365,360.00

323,136.00

316,434.00

302,464.00

298,616.00

%OFOWNER-

SHIP

0.01

0.01

0.01

0.01

0.01

0.01

0.01


AMOUNT PAID(PUP)

3,700,000.00

3,683,600.00

3,653,600.00

3,231,360.00

3,164,340.00

3,024,640.00

2,986,160.00

TAX IDENTIFICATION NO.(TIN) FOR FILIPINOS or

PASSPORT NO. FORFOREIGNERS

104-174-965

1 30-074-234

124-140-726

104-175-126

100-304-671

104-175-118

134-493-071

INSTRUCTION: SPECIFY THE TOP 20 STOCKHOLDERS AND INDICATE THE REST AS OTHERSJote: For PDTC Nominee included in the list, please indicate further the beneficial owners owning more than 5% of any class of the company's voting securities.Attach separate sheet, if necessary.



========== PLEASE PRINT LEGIBLY =========


TOTAL NUMBER OF STOCKHOLDERS: NO. OF STOCKHOLDERS WITH 100 OR MORE SHARES EACH:

TOTAL ASSETS BASED ON LATEST UNAUDITED FS: Php2,842,431, 329.00



1 5. MARIA ELENA A. CRUZ (ITF)

24 Heron St., Greenmeadows, Quezon City

16. MARIA ELENA A. CRUZ

24 Heron St., Greenmeadows, Quezon City

17. AURORA CORAZON C. ABELLADA

23 Sparrow St., Greenmeadows, Quezon City

18. JOSE COJUANGCO JR.

1226 Acacia road, Dasmarinas Village, Makati City

19.i MARIA CARMELA C. TEOPACO

cor. Juan Luna St., Corinthian Gargen, Quezon City

20. JOSE RAFAEL C. TEOPACO

cor. Juan Luna St., Corinthian Gargen, Quezon City

21. OTHERS (Indicate the number of the remainingstockholders)

SHARES SUBSCRIBED

TYPE

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

Common

TOTAL

TOTAL

NUMBER

294,784

294,784

294,584

294,584

294,580

294,580

268,880

268,880

220,644

220,644

219,644

219,644

6,169,870

6,169,870


AMOUNT(PhP)

294,784.00

294,584.00

294,580.00

268,880.00

220,644.00

219,644.00

6,169,870.00

28,253,876

%OFOWNER-

SHIP

0.01

0.01

0.01

0.01

0.01

0.01

0.25


AMOUNT PAID(PhP)

2,947,840.00

2,945,840.00

2,945,800.00

2,688,800.00

2,206,440.00

2,196,440.00

61,698,700.00

282,538,760

TAX IDENTIFICATION NO.(TIN) FOR FILIPINOS orPASSPORT NO. FOR

FOREIGNERS

104-174-973

104-174-973

138-045-273

105-548-046

112-099-241

104-175-118

N/A

INSTRUCTION: SPECIFY THE TOP 20 STOCKHOLDERS AND INDICATE THE REST AS OTHERS

Note: ForPDTC Nominee included in the list, please indicate further the beneficial owners owning more than 5% of any class of the company's voting securities.Attach separate sheet, if necessary.

GIS_STOCK(v.2013) Page 6


= = = = = = = = = -- = = = = -- = = = = = = -1 PLEASE PRINT LEGIBLY = = = = = = = = = = = = = = = = = = = = =

CORPORATE NAME: CENTRAL AZUCARERA DE

1. INVESTMENT OF CORPORATEFUNDS IN ANOTHER CORPORATION1.1 STOCKS

1.2 BONDS/COMMERCIAL PAPER(Issued by Private Corporations)

1 .3 LOANS/ CREDITS/ ADVANCES

1.4 GOVERNMENT TREASURY BILLS

1.5 OTHERS

TARLAC.

AMOUNT (PhP) DATE OF BOARD RESOLUTION

2. INVESTMENT OF CORPORATE FUNDS IN ACTIVITIES UNDER ITS DATE OF BOARDSECONDARY PURPOSES (PLEASE SPECIFY:) RESOLUTION

N/A

3. TREASURY SHARESNO. OF SHARES

720

DATE OFSTOCKHOLDERS

RATIFICATION

% AS TO THE TOTALNO. OF SHARES

ISSUED

4. UNRESTRICTED/UNAPPROPRIATED RETAINED EARNINGS AS OF END OF LAST FISCAL YEAR Deficit (367,787,403.00)

5. DIVIDENDS DECLARED DURING THE IMMEDIATELY PRECEDING YEAF N/A

TYPE OF DIVIDEND

| 5.1 CASH

5.2 STOCK

5.3 PROPERTY

TOT^

AMOUNT (PhP)

N/A

N/A

N/A

iL P

DATE DECLARED

N/A

N/A

N/A

6. ADDITIONAL SHARES ISSUED DURING THE PERIOD:

DATE

| N/A

NO. OF SHARES AMOUNT

N/A N/A

SECONDARY LICENSE/REGISTRATION WITH SEC AND OTHER GOVT AGENCY:NAME OF AGENCY:

TYPE OFLICENSE/REGN.DATE ISSUED:

DATE STARTEDOPERATIONS:

SEC

N/A

TOTAL ANNUAL COMPENSATION OF TOTOFFICERS/ DIRECTORS DURING THE

PRECEDING FISCAL YEAR (in PhP) 6,989,354

BSP 1C

N/A N/A

"AL NO. OF OFFICERS TOTAL NO. OF RANK &8 FILE EMPLOYEES -

624

TOTAL MANPOWERCOMPLEMENT -753

NOTE: USE ADDITIONAL SHEET IF NECESSARY I

GIS_STOCK(v.2013) Page?

I, ADDISON B. CASTRO Corporate Secretary(NAME) (POSITION)

THE ABOVE-MENTIONED CORPORATION DECLARE UNDER THE PENALTY OF PERJURY, THAT ALL MATTERS SEFORTH IN THIS GENERAL INFORMATION SHEET WHICH CONSISTS OF ( 8 ) PAGES HAVE BEEN MADE IN GOODFAITH, DULY VERIFIED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, ARE TRUE AND CORRECT.

I UNDERSTAND THAT THE FAILURE OF THE CORPORATION TO FILE THIS CIS FOR FIVE (5) CONSECUTIVEYEARS SHALL BE CONSTRUED AS NON-OPERATION OF THE CORPORATION AND A GROUND FOR THEREVOCATION OF THE CORPORATIONS CERTIFICATE OF INCORPORATION. IN THIS EVENTUALITY, THECORPORATION HEREBY WAIVES ITS RIGHT TO A HEARING FOR THE SAID REVOCATION.

DONE THIS DAY OF "Ol/ ] 9 9Q1 j IN Makati City

SUBSCRIBED AND SWORN TO BEFORE ME IN *~ *

(SIGNATURE)

CITY/PROVINCE, PHILIPPINES ON

AFFIANT PERSONALLY APPEARED BEFORE ME AND EXHIBITED TO ME HIS/HER DRIVERS LICENSE

NO.N10-83-017000.

DOC. NO:PAGE NO.30OK NO.SERIES OF 2013

NOTARY PUBNotarial ComCommission e:Roll of AttorniPTR No.IBP No.

CITY/PROVINCE

3QLL 24655 / TIN -144 • j 1 JOffice Address: .MOLE HI -OC13621

Com No 201;*-


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