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Paste Passport Size ID Photo Here AMD Form N ‐ 01a Revised July 2013 BANGKO SENTRAL

AMD Form N01a Revised July 2013

BANGKO SENTRAL NG PILIPINAS

ASSET MANAGEMENT DEPARTMENT

Telephone Nos. 3063422, 3063423 3062914

BUYER’S INFORMATION SHEET

(For Individuals)

For TCT

No.

_________________ Location _________________

(Please complete required information. If not applicable put N/A.)

BUYER’S PERSONAL DATA Last Name: First Name: Middle Name: Permanent Home Address: ( No. Street, Subdivision,
BUYER’S PERSONAL DATA
Last Name:
First Name:
Middle Name:
Permanent Home Address: ( No. Street, Subdivision, Barangay, City/Municipality, Province)
Home Tel. No.:
Home Ownership:
Present Home Address: ( No. Street, Subdivision, Barangay, City/Municipality, Province)
Home Tel. No.:
Owned Mortgaged
Rented at P _____________
Living With Relatives
Date of Birth:
Place of Birth:
Age:
Sex:
Civil Status:
No. of Dependent/s:
Male
Single
Married
Annulled
Female
Widow/er Legally Separated
Nationality:
ACR/No. SIRV / SRRV No., if applicable
TIN:
Fax No.:
Cellphone No.:
E‐Mail Address:
Government Issued ID
Issued By and No.:
Date and Place Issued:
IF EMPLOYED
IF ENGAGED IN BUSINESS
Company/Institution:
Business or Trade Name:
Company Address:
Nature of Business:
Telephone No.:
Business Address:
Gross Monthly Income:
Net Income for the Immediately Preceding Year:
Other Source of Family Income
Source / Nature
______________________
______________________
References
Amount per Year
P ______________
______________
Name
Address
Contact No.
_______________
__________________
_____________
_______________
__________________
_____________
SPOUSE’S PERSONAL DATA
Last Name:
First Name:
Middle Name:
Date of Birth:
Citizenship:
Age:
TIN:
Cellphone No.:
Email Address:
Company/Employer/Business Name (if self‐employed):
Company/Employer/Business Address:
Office Landline:
EXISTING LOAN ACCOUNTS/OUTSTANDING CREDITS (Please use a separate sheet, if necessary)
Type of Loan:
Bank / Financial Institution / Creditor & Address:
Original Amount:
Monthly Payment:
Outstanding Balance:
Maturity Date:
OTHER ASSETS
CREDIT HISTORY
(Please use a separate sheet, if necessary)
Type of Property/Investment: (e.g. house, car) Do you have an existing loan with other banks, financial institutions or government agencies such as PAG‐IBIG, GSIS or SSS ?
Yes No If yes, please give details and submit proof of last amortization payment
Location/Description:
Are there cases, past or pending, civil or criminal, filed against you involving non‐payment of obligations or mishandling or issuance
of bouncing checks? Yes No If yes, please state the nature and status of the case ____________________________
Estimated Value:
CERTIFICATION
I hereby certify that the above statements are true, correct and complete to the best of my knowledge and belief and hereby agree that any misrepresentation or
non‐disclosure of a material fact shall be a ground for the disapproval of my offer. I agree to notify the BSP of any change in my personal circumstances and/or any material change
in the data stated herein. I likewise authorize the BSP to undertake whatever investigation or verification to check the validity or information contained herein. Lastly, I understand
that it may be a criminal offense punishable by fine or imprisonment, or both, to knowingly make untruthful statements or related falsehoods upon any material matter concerning
any of the above statements under the criminal laws of the Philippines.
____________________________
Date
_____________________________
Signature Over Printed Name
JURAT
DOCUMENTARY REQUIREMENTS
Republic of the Philippines)
City of Manila
Put a mark on the items submitted:
) S.S.
(
)
SUBSCRIBED AND SWORN TO BEFORE ME THIS
DAY OF
, 2011 AT
BY
(
)
(
)
___________________________
(Name of Buyer)
__________________
Com. Tax Cert. No.
___________________
Date and Place of Issue
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)
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)
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)
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Doc
_____________
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)
Page
____________
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Proof of Income (latest Income Tax Return, Payslip, etc.)
Certificate of Employment
DTI Certificate of Registration/Business Permit (photocopy)
One passport size ID picture
Government Issued ID & BIR TIN
Statement of Bank Account or Photocopy of Passbook
Bank Certification on Investment, if any (photocopy)
For non‐resident alien – Affidavit on Total Landholdings
Special Power of Attorney, if represented
Book
____________
Series
___________