KYC No.

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Prudential Guarantee and Assurance, Inc.
Coyiuto House 119 C. Palanca St. Telephone Number: 810-4916
Legaspi Village, Makati City Website: www.prudentialguarantee.com

CLIENT INFORMATION SHEET- For Corporate/Juridicial-Entity Client

Business Name: BROOKSIDE LANE CONSTRUCTION AND DEVELOPMENT

Official/Principal Business Address: BROOKSIDE LANE ST, SAN FRANCISCO, GEN. TRIAS, CAVITE CITY
Nature of Business: CONSTRUCTION AND DEVELOPMENT
Contact Numbers: (046) 489-4212/402 0585 TIN: 008-958-730
Date of Incorporation: FEB. 13, 2015 SEC Reg. No.: CS201502739
Principal Officers**:HIPOLITO & ELIZABETH PAGENTE
Principal Stockholders owning at least 2% of the capital stock**: SAME AS ABOVE
Name and Position of Authorized Representative: HIPOLITO P. PAGENTE Date: JULY 28, 2017
Form Accomplished by (Name and Signature): HIPOLITO P. PAGENTE (SGD)

This portion is to be filled up by Prudential Guarantee:

Assured Code/s: ___________________________________________________________ Intermediary: ____________________________

* As mandated by Philippine Anti-Money Laundering Act and Its Implementing Rules and Regulations
** Please use addition sheets if necessary

Important: Please attach Articles of Incorporation/Partnership, By-laws and General Information Sheet
PGA-KYC-Form-02.03
01-29-2014