SEC - Form 10.1 - Notice of Exempt Transactions PDF

__________________________________________________ _________________
Name of issuer whose securities are being offered for sale or sold Date
SECURITIES AND EXCHANGE COMMISSION

SEC FORM 10-1
NOTICE OF EXEMPT TRANSACTION UNDER 10.1(k)/ APPLICATION FOR CONFIRMATION
UNDER SECTION 10.1 OF THE SECURITIES REGULATION CODE
Check Applicable Box:
Notice of Exempt Transaction under 10.1(k).
Application for Commission confirmation that the transaction qualifies as an exempt

transaction under Section 10.1 of the Securities Regulation Code (Code).
1. Where the Commission confirmation is being requested, state the provision of Section 10.1 of the
Code under which confirmation is being requested:
____________________________________________________________________________________
2. Information about the securities for which this Notice/Application has been filed:
(a) Title of class of securities being offered for

sale/sold
(b) Number and price/value of the securities being
offered for sale/sold
(c) Are any of the issuer’s securities listed on the
Philippine Stock Exchange and, if so, describe which
class is listed and latest trading price.
(d) Are the securities traded on any other trading
market and, if so, disclose latest trading price
3. Additional information about the securities where this notice is filed by the issuer thereof:
(a) Exact name of issuer as specified in its charter
(b) Place (province, country or other jurisdiction of

incorporation) and date thereof
(c) SEC Identification Number
(d) BIR Tax Identification Number
(e) Address of principal office
(f) Issuer’s telephone number,including area code
(g) Former name or former address, if any,

since filing of last report with the SEC
(h) Are any of the issuer’s securities listed on the

Philippine Stock Exchange and, if so, describe which
class is listed and latest trading price.
SEC Form 10-1

Date ________ 1
(i) Other securities registered with the Commission
under the Revised Securities Act or the Securities
Regulation Code (title of each class, number of
shares of common stock and amount of debt
outstanding, date of registration)
(j) Describe any other offer for sale/sale of securities
by the issuer for the last 12 months for which
exemptive relief from registration was claimed under
RSA or Section 10.1 of the Code (whether or not this
form was filed
(k) Name of underwriter or selling agent involved in
the sale
4. If securities are being sold by the owner thereof, please disclose:
(a) Name of Selling Owner or

Owner’s Representative
(b) Date of acquisition and from whom (issuer,
another person)
(c) Price of securities when acquired
5. Terms and Conditions of the Sale:
(a) Date and place of initiation of selling efforts

(or proposed date and place of sale if prior
confirmation is requested)
(b) Unless being sold by the issuer or the owner,

please disclose name of person selling the securities
and his authority
(c) Lock-Up Period
(d) Summary of other terms and conditions of the

sale.
6. Information about purchasers
(a) Name, address and legal residence of each

purchaser, and indicate whether each purchaser is a
“qualified buyer” under Section 10.1(1) of the Code.
(b) Number of shares which shall be purchased/

purchased by each purchaser
(c) For each purchaser, indicate whether such

person is an officer, director or holder of at least 5%
of any class of equity shares of the issuer
(d) Indicate the class, number, and percentage of all

shares of the issuer already owned by each
purchaser
2
7. Exhibits When Notice Being Provided
In addition to the above information, the applicant hereby submits with this Notice the following documents:
(a) Written Disclosure to Investors containing the required information under Paragraphs (1) and (4)(d)
of SRC Rule 10-1; and
(b) Copy of other materials to be used/used in connection with the offering for sale or sale.
8. Filing Fees in Connection with an Application for Confirmation
This application for confirmation of availability of an exemption under SRC Rule 10.1 of the Code has been submitted
along with the payment of the prescribed fee in the amount of ___________________ under O.R. No.
________________. (Fill this up if applicable only)
Signatures
The undersigned hereby certifies that the exemption applied for hereunder is available and all requirements set forth
in SRC Rule 10-1 have been complied with.
Pursuant to the requirements of the Code and SRC Rule 10-1 thereunder _________________________________
(Name of Seller)
has caused this certification to be signed on its behalf by a duly authorized person who, in case of a juridical person,
shall be the President thereof.
Date: _____________________________
By: _______________________________
Position
Instruction
The applicant shall file with the Commission five (5) copies of this SEC Form 10-1, one of which shall be manually
signed by a duly authorized person who, in case of a juridical person, shall be the President.

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__________________________________________________ _________________

SECURITIES AND EXCHANGE COMMISSION

Check Applicable Box:

Notice of Exempt Transaction under 10.1(k).

Application for Commission confirmation that the transaction qualifies as an exempt

(a) Title of class of securities being offered for

(a) Exact name of issuer as specified in its charter

(b) Place (province, country or other jurisdiction of

(g) Former name or former address, if any,

(h) Are any of the issuer’s securities listed on the

SEC Form 10-1

4. If securities are being sold by the owner thereof, please disclose:

(a) Name of Selling Owner or

5. Terms and Conditions of the Sale:

(a) Date and place of initiation of selling efforts

(b) Unless being sold by the issuer or the owner,

(d) Summary of other terms and conditions of the

6. Information about purchasers

(a) Name, address and legal residence of each

(b) Number of shares which shall be purchased/

(c) For each purchaser, indicate whether such

(d) Indicate the class, number, and percentage of all

8. Filing Fees in Connection with an Application for Confirmation

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