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SECURITIES
AND EXCHANGE COMMISSION
SEC
FORM ExA-001
INITIAL APPLICATION FOR ACCREDITATION OF
AN INDIVIDUAL EXTERNAL AUDITOR
1.
Name of
Applicant:
..
2.
Place of
Birth/Birthday:
.
Age:
3. Telephone number and Complete
Address:
....
4.
Education:
Course
|
Name
of School
|
Year
Finished/Honors Received
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Accountancy
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Other Collegiate Course/s
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Post-graduate
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5.
CPA Certificate/License Number:
Date Granted:
6. Audit Experience:
Name of Firm
(if
applicable)
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Position/Function
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Period
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List
of
Corporate
Clients
(indicate
amount of assets)
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7.
Exhibits
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A
copy of the Statement of Representation as required under paragraph
3(c)(v) of SRC Rule 68 which may be submitted only once;
-
Copy
of updated PRC license and Certificate of Registration as a public
practitioner issued by the Board of Accountancy (BOA)/Professional
Regulation Commission (PRC);
-
Notarized
certification of the external auditor that he is in compliance with the
general qualification requirements under Section 5.1 (i) to (vi) of SEC
Circular No.____, Series of 2002, and that he has not been convicted by a
competent court for a crime involving moral turpitude or fraud (as defined
in the Revised Penal Code), or declared liable by the Commission or by any
competent court for violation of the Corporation Code or the Securities
Regulation Code.
8.
Processing Fee
This
application for accreditation has been submitted along with the payment of
the prescribed fee in the amount of ___________________ under O.R. No.
________________
I hereby
certify that the foregoing information are true and correct.
____________________________
Applicants Signature
Date:
_________________________
Place:_________________________
J U R A T
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