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PHILIPPINE CANINE CLUB, INC.

Rm. 206 Hillcrest Condominium


1616 E. Rodriguez, Sr. Avenue corner Hillcrest Street
Cubao, Quezon City, Philippines
Tel: +63 (2) 7218345 / Fax: +63 (2) 7217152
Email: info@pcci.org.ph
Website: www.pcci.org.ph

LISTING APPLICATION FORM


Date: ____________________________ Breed: __________________________

Name of Dog: __________________________________________________________

Sex: _________________________ Date of Birth: __________________________

Color & Markings: _______________________________________________________

Microchip No: __________________________________________________________

Sire Name: ____________________________________________________________

Sire Reg. No: __________________________________________________________

Dam Name: ____________________________________________________________

Dam Reg. No: __________________________________________________________

Breeder: ______________________________________________________________

Name of Owner(s): ______________________________________________________

PCCI Membership No: ___________________________________________________

Address: ______________________________________________________________

______________________________________________________________

Tel No: __________________________ Email: ___________________________

OR Number: _____________________ OR Date: _______________________

Note: Attached colored pictures of the dog (front & side view).

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