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4 0 9 7 9 SEC Registration Number
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(Company's Full Name)
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Address : No. Street CityiTown/Province)
637-2917
ARLAN P. PROFETA
(Company TelePhone Number)
(Contact Person)
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Month
A C G
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Month
DaY (Annual Meeting)
Day
(Fiscal Y ear)
{Secondary License Type,
If Applicable)
Amended Articles Number/Section
Dept. Requiring this Doc.
Total Amount of Bonowings
Domestic
Total No. of Stockholders
Foreign
To be accomplished by SEC Personnel concemed
File Number
LCU
Cashier
{r-
Remarks: Please use BLACK ink for scanning purposes'
