Republic of the Philippines
Office of the President
GAMES AND AMUSEMENTS BOARD
Makati City
APPLICATION FOR LICENSE
License Applied For:
New
Renewal
(PLEASE CHECK APPROPRIATE BOX)
Name:
Tel.No. (HOME)
(Surname)
(First Name)
(M.I.)
Home Address:
(NO.)
(STREET)
(TOWN)
Office Address:
Tel.No. (OFFICE))
Date of Birth:
Citizenship:
(CITY/PROVINCE)
Place of Birth:
Civil Status:
Sex:
Age:
Height:
Weight
Company/Club:
Have you ever been accused or convicted of any crime? (If yes, state the nature of Offense)
I HEREBY CERTIFY that the foregoing information and data together with the attached papers are
true and correct. Should this application be approved, I bind myself to uphold and comply with the
provisions of the law governing the sports or games and the rules and regulations promulgated thereunder,
and all resolutions adopted or which may hereunder be adopted by the Board.
Date:
(APPLICANT'S SIGNATURE)
SUBSCRIBED AND SWORN TO before me this____day of _______________________________
by ____________________________________________________ who exhibited to me his Residence
Certificate
No./Passport
No.
__________________
issued
at
__________________
on
___________________.
Doc. No. ____________
Page No. ____________
Book No. ____________
Notary Public
Series of ____________
Until December 31, _____
APPROVED / DISAPPROVED
Date: _________________________
JUAN RAMON R. GUANZON
Chairman