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    BPI Customer Information Sheet 2019

    Uploaded by

    Ria de los Santos
    This document contains an individual customer information sheet for a bank. It requests personal details like name, date of birth, contact information, employment details, and FATCA declaration. The customer agrees to provide accurate information and consents to the bank processing their data in accordance with data privacy policies. They acknowledge reading and agreeing to the bank's terms and conditions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    BPI Customer Information Sheet 2019

    Uploaded by

    Ria de los Santos
    1K views1 page
    This document contains an individual customer information sheet for a bank. It requests personal details like name, date of birth, contact information, employment details, and FATCA declaration. The customer agrees to provide accurate information and consents to the bank processing their data in accordance with data privacy policies. They acknowledge reading and agreeing to the bank's terms and conditions.

    Original Description:

    BPI-Customer-Information-Sheet PDF

    Original Title

    BPI-Customer-Information-Sheet-2019

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    This document contains an individual customer information sheet for a bank. It requests personal details like name, date of birth, contact information, employment details, and FATCA declaration. The customer agrees to provide accurate information and consents to the bank processing their data in accordance with data privacy policies. They acknowledge reading and agreeing to the bank's terms and conditions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views1 page

    BPI Customer Information Sheet 2019

    Uploaded by

    Ria de los Santos
    This document contains an individual customer information sheet for a bank. It requests personal details like name, date of birth, contact information, employment details, and FATCA declaration. The customer agrees to provide accurate information and consents to the bank processing their data in accordance with data privacy policies. They acknowledge reading and agreeing to the bank's terms and conditions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    CUSTOMER INFORMATION SHEET (INDIVIDUAL)

    RM NO.:
    PERSONAL INFORMATION
    Last Name First Name Middle Name Suffix

    Date of Birth (mm-dd-yyyy) Place of Birth (City, Country) Citizenship Sex


    Male  Female
    Marital Status Mother’s Maiden Name ID Presented (ID type, number)
     Single  Married  Others:_________

    CONTACT INFORMATION
    Mobile (+Country Code-Area Code-Tel.no.) Landline (+Country Code-Area Code-Tel.no.) Email Address

    Address (House/Lot/Block/Unit no., Floor & Building, Street, Subdivision/Barangay/Village)

    District/Town City/Municipality/Province Country Zip Code

    FINANCIAL INFORMATION (*please indicate applicable code per List of Values provided)
    Employer / Business Name Nature of Work (Job Title)* Nature of Business / Self- Source of Income/Wealth***
    employment**

    FATCA DECLARATION
     I am not a U.S. Person  I am a U.S. Person  I am not a U.S. Person but with U.S. Indicators
     U.S. Citizen U.S. Place of Birth (1 & 2) Required Documents (Submitted)
     U.S. Resident (Green Card) U.S. Telephone Number (1)  1. W8 BEN
    U.S. TIN: ___________  U.S. Address (1)  2. Any of the following:
    U.S. ID : ___________
    With Power of  Certificate of Loss of US
     W9 (Submitted) Attorney/Signatory (1) Nationality
    With Standing Instruction (1)  Written explanation of not having
    In care of/Hold Mail (1) such certificate despite the
    renunciation
     Written explanation on why US
    citizenship not obtained at birth

    CERTIFICATION AND AUTHORIZATION


    By signing this form, I hereby certify that the information I provided herein is true, accurate and complete, and I agree to notify/update the Bank of any
    change in any of the information supplied in this form.
    As to the FATCA Declaration, I authorize the Bank to rely upon the same and, if I am a US Person or have US indicators that render my account
    reportable under FATCA, I consent to the reporting and disclosure of the required information by the Bank to the Internal Revenue Services (IRS) and/or
    Bureau of Internal Revenue (BIR) in compliance with FATCA. In consideration of the foregoing, I agree to hold the Bank, its directors, officers, employees,
    representatives and agents free and harmless from any liability, action and suits, costs, and expenses, arising from or in connection with the Bank’s
    compliance with FATCA regulations and/or as a result of disclosure made to the US IRS and/or BIR.
    I acknowledge to have read and understood, and I agree to be bound by, the terms and conditions of the deposits, products, services, facilities and/or
    channels which I open/avail of, as the same may be amended from time to time. Such terms and conditions are provided and/or are made available to me
    via www.bpi.com.ph and/or other channels.

    I likewise acknowledge to have read and understood the Bank’s Data Privacy Statement, posted on www.bpi.com.ph and in branch premises, and I agree
    that the Bank and/or its agents may, as described in said Data Privacy Statement, process, obtain, collect, record, organize, store, update, modify, use,
    access, share and/or disclose to the Bank’s subsidiaries, affiliates, and third parties, information relating to me and/or my account(s) of whatever nature.
    The consent given herein is deemed to be the consent required under bank deposit confidentiality laws of the Philippines or other jurisdictions including
    but not limited to RA 1405 (An Act Prohibiting Disclosure of or Inquiry into, Deposits with any Banking Institution and Providing Penalty Therefor), RA 6426
    (The Foreign Currency Deposit Act) and RA 8791 (The General Banking Law) and under data privacy laws of the Philippines or other jurisdictions,
    including but not limited to RA 10173 (The Data Privacy Act).

    If I am, become, or apply to become a client of any of the Bank’s subsidiaries or affiliates, I agree that the latter has the option but not the obligation to rely
    on the above information for any and all of the concerned subsidiary’s or affiliate’s account opening, maintenance and transaction requirements.
    NOTE: Should you wish to change your elected mailing address for any of your accounts, please visit any of our branches to submit an Amendment Form.
    Customer’s Signature: Date:

    FOR BANK USE ONLY

    Remarks:
    Processed and signature verified by: Approved by:

    Form No. BPI-CIS IND-12182019

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