RESELLER ACCREDITATION PERSONAL INFORMATION DATA (RAPID) Registration Form We are glad to know that you are interested to be a reseller of our Products. Kindly take a few minutes of your time to complete the blanks below. (Natutuwa kaming malaman na ikaw ay interesado na maging reseller ng aming Produkto. Pakisagutan ang mga hinihinging impormasyon sa baba nito. From whom did you know about our reselling program? (Kanino mo nalaman ang tungkol sa aming reselling program?) * Siomai House Employee Siomai House Reseller OTHERS Siomai House Franchise Siomai House Social Media Nearest SIOMAI HOUSE OUTLET (Pinakamalapit na SIOMAI HOUSE OUTLET) * Full Name (Buong Pangalan) Gender (Kasarian) Male Female Civil Status (Katayuang Sibil) Single Widowed Divorced Married Separated Citizenship (Pagkamamamayan) Birthdate (Araw ng kapanganakan) Place of Birth Take a selfie Take a photo of at-least two of your government issued Identification Cards. (Kunan ng larawan ang kahit 2 sa inyong mga government issued ID's) * Example Current Home Address (Kasalukuyang Tinitirhan) * --Select Province-- Ilocos Norte Ilocos Sur La Union Pangasinan Batanes Cagayan Isabela Nueva Vizcaya Quirino Bataan Bulacan Nueva Ecija Pampanga Tarlac Zambales Aurora Batangas Cavite Laguna Quezon Rizal Marinduque Occidental Mindoro Oriental Mindoro Palawan Romblon Albay Camarines Norte Camarines Sur Catanduanes Masbate Sorsogon Aklan Antique Capiz Iloilo Negros Occidental Guimaras Bohol Cebu Negros Oriental Siquijor Eastern Samar Leyte Northern Samar Samar Southern Leyte Biliran Zamboanga del Norte Zamboanga del Sur Zamboanga Sibugay City of Isabela (Not a Province) Bukidnon Camiguin Lanao del Norte Misamis Occidental Misamis Oriental Davao del Norte Davao del Sur Davao Oriental Davao de Oro Davao Occidental Cotabato South Cotabato Sultan Kudarat Sarangani City of Cotabato (Not a Province) NCR, City of Manila, First District (Not a Province) NCR, Second District (Not a Province) NCR, Third District (Not a Province) NCR, Fourth District (Not a Province) Abra Benguet Ifugao Kalinga Mountain Province Apayao Basilan Lanao del Sur Maguindanao Sulu Tawi-Tawi Agusan del Norte Agusan del Sur Surigao del Norte Surigao del Sur Dinagat Islands Social Media Accounts * Mobile Number (Telepono) Other Contact Number (Ibang numero kung saan pwede matawagan) Active Email (Email Address na ginagamit) Other food business name and registration number (SEC/DTI), if any. If online business, kindly provide the link to your website or social media page. (Pangalan ng iyong Negosyo at Rehistro (SEC/DTI), kung meron man. Kung online business, ibigay ang link sa iyong website or social media page.) Ex. BUSINESS NAME / SEC or DTI REG # : 88888888 Ex. ONLINE BUSINESS / facebook.com/myonlinestore Mode of Transportation Motor Car Public Transportation OTHERS Cold Storage availability? (Mayroon ka bang malamig na imbakan?) Freezer/Refrigirator Ice Box OTHERS Styro Box Thermal Bags Declaration I hereby confirm that I have read and understood all the provisions stated in the Basic Instruction Bernabest Livelihood Entrepreneurship (BIBLE) . (https://sites.google.com/view/siomaihousesharebible) . I hereby also confirm that the information provided herein is accurate, correct and complete and the documents submitted are genuine to the best of my knowledge. I undertake to inform Siomai House in writing of any changes to the information already provided and to update the information on this form whenever requested to do so . I further understand that any false, inaccurate or misleading statements may result in denial or revocation of my accreditation as Siomai House reseller. * Submit
