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SECURITIESAND EXCHANGE COMMISSION APPLICATION FOR REGISTRATION RENEWAL CERTIFIED INVESTMENT SOLICITOR CIS For the year To be accomplished in 4 copies with cover sheet 3 copies for SECand 1 receiving copy for the applicant Last Name Rrst Name Middle Name TIN Certificate of Registration No. Residential Address Name of Employer Firm Firm s Principal Business Address street City Branch 10 Province Office of Employment Postal Code Address The above-named employer hereby makes application for the renewal registration of the individual and hereby certifies that the information contained in his/her most recent filing of SEC Form ICA-CiS is true correct current accurate and complete. All registered Certified Investment Solicitors ore required to update SEC Form ICA-CiS information by submitting amendments wherever information on file becomes inaccurate for any reason within seven 7 days of any change to the information previously filed. Printed Name/Signature Staple applicant s 2x2 B W 10 picture with signature and printed name at the back of Company President Reviewed by Officer of Compliance of Applicant Date. --. Subscribed and sworn to before me this valid identity card day of issued at -. -. 201. exhibited to me his/her on Notary Public OocNo. Page No. Book No. Series Four sets of duly accomplished SEC Form ICA-RCIS for certified investment solicitors with original signatures of the applicant with cover sheet Two pieces current 2x2 10 picture with the signature and printed name of the applicant affixed on the dorsal side of each picture. All registered Certified Investment Solicitors ore required to update SEC Form ICA-CiS information by submitting amendments wherever information on file becomes inaccurate for any reason within seven 7 days of any change to the information previously filed* Printed Name/Signature Staple applicant s 2x2 B W 10 picture with signature and printed name at the back of Company President Reviewed by Officer of Compliance of Applicant Date. --. Subscribed and sworn to before me this valid identity card day of issued at -. -. 201. exhibited to me his/her on Notary Public OocNo* Page No* Book No* Series Four sets of duly accomplished SEC Form ICA-RCIS for certified investment solicitors with original signatures of the applicant with cover sheet Two pieces current 2x2 10 picture with the signature and printed name of the applicant affixed on the dorsal side of each picture. The 10 pictures must be attached on the application form by stapling the 10 picture on the top edge for easy inspection of the signature and printed name on its dorsal side Copy of previous license and Payment of renewal fee - PhP1 015. All registered Certified Investment Solicitors ore required to update SEC Form ICA-CiS information by submitting amendments wherever information on file becomes inaccurate for any reason within seven 7 days of any change to the information previously filed* Printed Name/Signature Staple applicant s 2x2 B W 10 picture with signature and printed name at the back of Company President Reviewed by Officer of Compliance of Applicant Date. --. Subscribed and sworn to before me this valid identity card day of issued at -. -. 201. exhibited to me his/her on Notary Public OocNo* Page No* Book No* Series Four sets of duly accomplished SEC Form ICA-RCIS for certified investment solicitors with original signatures of the applicant with cover sheet Two pieces current 2x2 10 picture with the signature and printed name of the applicant affixed on the dorsal side of each picture.

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