Form PRAASA MEMBERSHIP FORM
Form PRAASA MEMBERSHIP FORM
Form PRAASA MEMBERSHIP FORM
INFORMATION SHEET
NAME OF AGENCY: _____________________________________ OWNER: ______________________
ADDRESS: ____________________________________________ RESIDENCE: __________________
______________________________________________________ ______________________________
TEL NOS.: ___________________ FAX: _____________________ BIRTHDATE: ___________________
POEA License No.: _______________ Date Issued: ____________ TEL NO.: ______________________
Email address: ______________________________ CELLPHONE: __________________
COMPANY OFFICERS:
Name Position
___________________________________ ___________________________
___________________________________ ___________________________
___________________________________ ___________________________
I hereby certify that all information contained herein are true and correct
to the best of my knowledge.
___________________________
(Signature Over Printed Name)
Date: ___________________
NOTE: Please attach copy of POEA License, SEC/BDT Registration, Resume & 2x2 picture of representative/s.
ACTION TAKEN:
Membership Committee:
Recommending: Approval Denial
CHAIRMAN: ________________________________________