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Broker Application Form — Local Broker Network Group
Application For
Please select from the Drop
Individual Broker
Corporate Broker
Associate Broker
Enter your details
Full Name
Complete Address
Residence Phone No.
Mobile Phone No.
Zip Code
Email Address
Age
Nationality
Date of Birth
mm/dd/yyyy
Civil Status
Civil Status
Select Civil Status
Single
Married
Separated
Widowed
Gender
Gender
Select Gender
Male
Female
Additional Details
Tax ID or TIN No. (For Filipinos Only)
Social Security No. (SSS)
Realty Information / Real Estate Specific License Information
Broker Name
Office Address
Organization/Brokerage
PRC Number
HLURB Registration No.
Realtor License No.
Real Estate License No.
List of Agents
Agent 1
Name of Agent
Mobile No.
Email Address
Agent 2
Name of Agent
Mobile No.
Email Address
Agent 3
Name of Agent
Mobile No.
Email Address
Agent 4
Name of Agent
Mobile No.
Email Address
Agent 5
Name of Agent
Mobile No.
Email Address
Broker Consultancy
mm/dd/yyyy
Date of Accreditation
mm/dd/yyyy
Valid PRC/ID
Upload Google Drive/Dropbox Link
Individual Brokers
Photocopy of PRC-issued Real Estate Broker's License
Photocopy of HLURB Registration for Real Estate Broker (Or reciept)
BIR Form 2303 or BIR Certificate of Registration
Sworn Statement (NON-VAT Reg)
Photocopy of Official Receipt
1pc 1x1 or 2x2 Picture
AMLC Registration
Broker Groups
Photocopy of PRC-issued Real Estate Broker's License
Photocopy of HLURB Registration for Real Estate Broker (Or reciept)
BIR Form 2303 or BIR Certificate of Registration
DTI/SEC Registration
Articles of Incorporation & By-laws
Secretary's Certificate / Board Resolution
1pc 1x1 or 2x2 picture
AMLC Registration
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