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SECURITIES AND EXCHANGE COMMISSION SEC FORM 28. 1-4 APPLICATION FOR INDIVIDUAL REGISTRATION RENEWAL For the Year To be accomplished in four 4 copies with cover sheet 3 copies for SEC 1 receiving copy for the applicant Associated Person Last Name Salesperson First Name Middle Name Phone No. Residence Address Certificate of Registration No. TIN Name of Employer Firm Employer s Certificate of Registration No. Firm s Principal Business Address Branch ID Street City Office of Employment Address Province Postal Code Date when applicant passed the certification examination The above-named employer hereby makes application for the renewal of its registration of the above-named individual and hereby certifies that the information contained in his/her most recent filing of SEC Form 28. 1-4 is true correct current accurate and complete. Printed Name/Signature/Designation of Authorized Signatory Staple applicant s 2x2 black white ID picture with signature and printed name at the back Reviewed by Signature of Associated Person Signature of Applicant Date For SEC only SP Registration No* AP Registration No* 1. For the Associated Person who has not completed any or all of the certification seminar/s and passed the examination an explanation/justification stating the reasons for noncompliance with the certification requirement. 2. Current 2x2 black white I. D. picture. 3. Photocopy of previous year s AP/SP license 4. Payment of renewal fee P Signature of Processor SEC Form 28. 1-4 is true correct current accurate and complete. Printed Name/Signature/Designation of Authorized Signatory Staple applicant s 2x2 black white ID picture with signature and printed name at the back Reviewed by Signature of Associated Person Signature of Applicant Date For SEC only SP Registration No* AP Registration No* 1. For the Associated Person who has not completed any or all of the certification seminar/s and passed the examination an explanation/justification stating the reasons for noncompliance with the certification requirement. For the Associated Person who has not completed any or all of the certification seminar/s and passed the examination an explanation/justification stating the reasons for noncompliance with the certification requirement. 2. Current 2x2 black white I. D. picture. 3. Photocopy of previous year s AP/SP license 4. Payment of renewal fee P Signature of Processor SEC Form 28. 1-4 is true correct current accurate and complete. Printed Name/Signature/Designation of Authorized Signatory Staple applicant s 2x2 black white ID picture with signature and printed name at the back Reviewed by Signature of Associated Person Signature of Applicant Date For SEC only SP Registration No* AP Registration No* 1. For the Associated Person who has not completed any or all of the certification seminar/s and passed the examination an explanation/justification stating the reasons for noncompliance with the certification requirement. 2. Current 2x2 black white I. D. picture. 3. Photocopy of previous year s AP/SP license 4. Payment of renewal fee P Signature of Processor SEC Form 28.

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