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) * Please Select Country United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other 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
