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SECURITIES
AND EXCHANGE COMMISSION
SEC
FORM ExA-001-R
RENEWAL 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:
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Course
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Name
of School
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Year Finished/Honors Received
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Accountancy
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Other Collegiate Course
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Post-graduate
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5. CPA Certificate/License Number:
Date Granted:
6. Audit Experience:
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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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Copy
of updated PRC license and a Certification that the Certificate of
Registration as a public practitioner issued by BOA/PRC is still existing
and effective;
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Notarized
certification of the external auditor that he is in compliance with the
general qualification requirements under Section 5.1 (i) to (iii) of the
aforementioned Circular and that he has not been convicted by a competent
court for a crime involving moral turpitude, 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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