@Bwn« OF THE PHILIPPINE ISLANDS DATE BRANCH ACCT. NO. EIIIff RM NO. af Depositor + PHOTO PHOTO LTT Depositor 2 Qsinale Joint Cand Dor Tir IFAO, Name of Trustor Beneficial Owner: Dopsarort Depa? Number of Depositors:___ Signature. J Anyone EA Requirement: [7] any two _[] Others, please speciy: Depositor 1 DATE OF BIRTH Fava Tie Namo Tea ane Waters taten Nar Depositor 2 DATE OF BIRTH Fisnane Tao Nene Tas ane Tatara TRE TTS By asin my/our sanature[a) be. ire hereby authorize the Bank iohoncr and oflel our Waneastins on the boas Foreoh [ne Taher aarse > bo bounc by the Terms and Concition's gaverning the Bank's Deposts, Products, Services, Facilies ang Ghannels: tre tang of te Reraol earns Philppines as well as te rules and regulations sot by the Bangke Sentral ng Pilpinas relative to he esiavlishmenl are operation oF mje seco Wve netedy rrevocably and excressiy auihorze the Benk to submit a its sole option, myfour specimen signature/s, 2s appearng in tis Signature Card including cheeks, witrdravral sips or other documents to. approstiata government agencies and lan cnioresmant acthorigs ornare Yorifcation, examination, comparison and investigation in connection with alegatione cf fraud, forgery and siallar eases In relalon to he ecco PLEASE RECOGNIZE THE FOLLOWING SIGNATLRE/S IN THE PAYIMENT OF FUNDS OR TRANSACTION OF OTHER BUSINESS ON MY/OUR ACCOUNT 1 2 IMPORTANT: Please sign the SAME speciian Signature Sx, an Keep WITHIN THE BOX provided ATM Card received by: ATM Card received by:CUSTOMER INFORMATION SHEET ast Name, First Narne, Middle Name (\eae box and fr space) DOOOOOOOOOea JOONOUOOOOOOO DE ‘esent AdGreSs House/tnit No, Fao Bldg. /Steet, Lol, Bay lage “Resident Since vay | “$85 No. or GSIS No. CF EF IODA bist /Town Giy/Province country “Nationality “Tax Identification No, OOO simnenenit Address (not same as Home Address) House /Unit Na, Hoot & Bldg, sro, Lor/ak, Boy illage “Citizenship Season fr no Distvit/rown any/erounce ‘county *Mailing Address “Home Ownership \ Present owned —f 7 Peimanent TJ Used Free te of Birth “alrth Place “Email (Business SlRented P /month a eI. ma “| Martgaged P /month J0-~O0-mOO0O | | Living with Relatives sesidence Phone county ede sven Code Phone No “mobile Phone county cege Area ode thone No. | “Business Phone county Cade - Are Code Phone No | employer “employment Address (vo. street oistct/lown Giy/Peovince zip Cade) siness Name (1 Settemployed) Business Address (tia. suet Ditic/lown Giy/Provine Tip Coke) Title I GE Clerical /Rank and File (GOV - Government (Elected /Appointed), |] MGT - top Management/Senior Level (-) SAL - Sales Rep [5] REL- Religious Leader Contractual/Proby Please specity _| OFW - Overseas Filipino Worker (SEA - Seafarer [[] OTH - OTHERS, please FOA- Foreign Ambassador/Diplomat [-] MGR- Mar/Supervisor/middle Level) PRO - Professional TT1EC-Technical/computer sve ource of Funds (check al tet opp) | Allowance 110 - Donations /Contributions & the like (IP - Pension 7 O- OTHERS, pase speaty 8 - Business (1 F = Campaign Funds [UR~ Regular Remittances Commission T11- Interest on Savings/Placements/Investments (CS-Solary Sete Hired/Start of Business “Gross Monthly Income [| Under Php10,000 7] Php50,000 - Php249,999 L_] Php500,000 ~ Php999,999 «—O)-o D0 -woOoOOO “| Php 10,000 - Php49,999 _] php250,000 - Phpa99,999 L] php1,000,000+ usre/Type, of Employment/Business/Profession “Employment status (] Employed (EMP) LD Retired (RET) 1 Others, please specify see (0 eference eat the bac potion a is for sspeon a sen) 1 Self-employed (set) Housewife (HWP) I [ 1 Overseas Filipino Worker (OFW) 7 Student (STU) Ceaser | | Philippine Resident le Female (1 Yes C]No If no, country of residence Products to be availed of: jonal Attainment Marital Status Types of Accounts with BPI No. of Cars Owned Doctorate (1 High Schoo! Graduate Ci Unmarried —C divorced/annulled | Fi savings (1) rousing Loans) Master's Degree 7 Elementary Graduate (Separated Widowed Hi thecking (2) 5 time Deposit (6) College Degree (No Formal Schooling 1 Married [i Auto toan (3) credit card (7) Associate Degree [Investment (4) | No. of Credit Cards soes of Accounts with Other Banks “Car Ownership savings [) Auto Loan Housing Loan [Credit Card Please specify name of Bank Glowned rented month Checking [] Investment] time Deposit C)None —SSaaee ‘Diused Free C] mortgaged P /month fine = you an Officer, Director, Stockholder of a Company? IF yes, please indicate name of company ies. Father's Name Customer's Signature aver Printed Name unlSaaS Spouse's Name (Leave box bank or space) Last Name, First Name, Middle Name DOOOOOOOOOOOOOoO OOO ODOOOOooOoOoo000o0o Spouse's Birth Date ‘Spouse's TIN, SSS OF GSIS (as applicable) | Start Date with Employer/Business wm [1] -00 LJ) -ww LIE ILI JOOOHOOoOoOo wm ]E]-o0[ |) wy IO “Employment Status — Employer or Business Name (i set-empleyed) J employed (GIP) 7) Self-Employed (SEL) Overseas Filipino Worker (OFW) (Others, pease specty C] Retired (RET) _| Housewife (HWF) (1 Student (stu) “Nature/Type of Employment/ Business /Profession (Pease refer to relerenc fie athe beck pation ofthis four) Gross Monthly Income ObH0 "| under Php10,000 I Php10,000 - Php29,999 Ti Phps0,000 - Php249,999 Job Title (ete to tebe above foro ite) fetta abe above for ile). (J Php?50,000 ~ Php1,000,000 [1 Php1,000,000+ : " ; oo Children’s Names (Last Name, First Name, Middle Name) Birth Date (Mn /DD/YYYY) Gender RELATIONSHIP TO BFS6, BPI AND BPI SUBSIDIARIES AND AFFILIATES, ETC. (in line with BSP Cir.749) ‘Me you a Director, officer, or Stockholder (005) of GPI Family Savings Sank (BFSB), SPI, or any 8! subsidiary and/or affiliate? Yes IF yes, specify your company and position Company (e.g. BPI) Affiliation/Position No or affiliation. | (24g, Director) IF yes, specify the narne/s and relationship, | Name - Relationship to DOS - Company & Position such a5, but not limited to: (@. Juan Dela Cruz - First Cousin - BPI, AVP) Spouse, Relative by consanguinity or | affiliation (e.g. parent, child, brother, sister-in-law, grandparent, niece, uncle, first cousin, ete) or Others (e.g. general SSS partner, co-owner of collateral, etc), NEa dead ‘Are you enrolled in Express Online or other 24/7 channels? []Yes []No ‘Are you related to @ DOS of BFS6, BPI, or any BPI subsidiary and/or affiliate (e.g. BPI Leasing, BPI Capital, BP|/MS, ete) or the Ayala Group of Companies (e.g. Ayala Corp., Ayala Land Inc, etc)? | would like to enroll my Account No. in Express Online and other 24/7 Channels My Chosen Channel CIEOL [Mobile TiPhone Mobile No. for Mobile Banking; BPI CARDS APPLICATION AND ePAY VIRTUAL WALLET ACTIVATION 1 By signing on the space provided in this section, | hereby apply for 8Pi/8P! Family Savings Bank (the *Bank:) Credit Card and agree to activate BP! ePay virtual wallet for purchases online. In connection with my application and agreement for activation, | agree: + To the terms and conditions found on wavw«bpicards.com and www.bpiepay.com, respectively; + That my application is subject to the Bank's Credit Approval Processes and Guidelines; To submit other documents as 8P1/8PI Family Savings Bank may deem necessary and hereby authorize the Bank to conduct random verification and validation of the authenticity of the information and documents I submitted through inguiries with government agencies or third party agencies; and —— + To receive notifications, alerts, updates and promotional offets related to BPI ePay and EPI Credit Cards through the Customer's Signature over Printed Name mobile number and email address 1 provided herein or which | may provide in the future. wa IZ1- oo 0)- wl ] Gee MnO LUn aun By signing this form, | hereby certty that the information | provided herein is true, accurate and complete, and | agree to notify/update the Bank of any change in any of the information supplied in this form. | acknowledge to have read, understood and agreed to be bound by the terms and conditions of the deposits, products, services, facilities and/or channels which | opened/availed which were provided and/or are made available to me via wwww.bpiexpressanline.com, as the same may be amended from time to time. ‘hereby expressly agree, consent, and authorize the Bank and/ar its agents, whether manually or via electronic channels, to process, obtain, collect, ecord, organize, store, update, modify, use, access, share and/or disclose ("Process”), without need of prior notice to me, any and all information relating 10 my Account(s) in order to (@) facilitate, monitor improve the quality of, or otherwise service my account and such products, services, facilites and/or channels availed by me, and (b) to comply with legal, regulatory or ather obligations ofthe Bank under applicable local ar foreign laws, rules and regulations that impact the Bank such processing rey be conducted fal the duration, ane even aftr ne termination, of my availment of the Bank's products, services, facilities and/or channels. As used hefein, the term “Bank” shall include the Bank’s local ot foreign branches, its Parent company, any member of the BPI Group of Companies, and theit respective subsidiaries, afilates or other related companies, whether organized in the Philippines or in ‘other jurisdictions, and the Bank's agents, representatives and outsourced service providers and their respective outsourced providers. Without limiting the generality of the foregoing express consent and authorization, | hereby grant the Bank full permission to process information pertaining to my Account/s as may be required under such other cules and regulations which may be issued by the government, including but not limited to the Anti-Money Laundering Act, or other regulatory bodies of the Philippines ot by other foreign jurisdictions, ° | signify my interest in receiving invites to the marketing initiatives, campaigns and programs of Bank of the Philippine Islands (Bt) or any member of the BP! Group of Companies including those of its subsidiaries and affiliates. For this purpose, | hereby authorize Bank of the Philippine Islands to process, disclose and shave my personal information to the marketing teams of BPI, members of the BPI Group of Companies and its subsidiaries and affiliates. 1 agree to intorm BPI of any changes relating to my personal information. This consent and authorization remains valid and subsisting until otherwise revoked or cancelled in writing, % a = Customer's Signature aver Printed Name a val] 0011-1 aa: ‘wember: POX, Maxinum Deposit insuiance for tach Deposttor 500,000.“a FATCA INFORMATION - DECLARATION OF INDIVIDUAL ACCOUNT Note: The information in this section is being collected as part of BPI Group of Companies’ new account on-boarding procedures to fully comply with the requirements of Foreign Account Tax Compliance Act (FATCA).. 1. Ate you a citizen oF resident of the United States? 2. If yes, provide the following informatio austw OI INIIMI b.us Address Oyes CINo 3. Please list all countries for which you hold citizenship: Please confirm your FATCA status by checking the relevant column and indicate the date the IRS form is signed. a MM, 1..US Citizenship _ Z 2. US Resident - Green Card | 3. US Resident - Residing in the US for 183 days or more if any of your answer to numbers 1=3 is ES, please do not answer numbers 4, 5, 6, 7, 8 I any of your answer to numbers 1~3 is NO, please answer numbers 4,5, 6, 7, 8 4. US Place of Birth Us Resident/Mailing Address (Residence, Correspondence or PO. Box) an aad ra PM ea yeti Meramec use 4. IRS Form W-S; AND 2. US identification document (249. passport, etc) 1. IRS Form W-9; AND 2. US oF non-US identification document (e.g. passport, ciiver’s license ett) Any of the followin A. 1. IRS Form W-8BEN; AND 2. Copy of individual's Certificate of Loss of Nationality of the US; AND 3. Non-US identification document (e.g. passport, driver's license, ete); OR 8.1. Non-US identification document (e.g. pesspartt, driver's license, etc.); AND. 2. Written explanation of your renunciation of US citizenship or the reason you did not obtain US citizenship at birth, 6. US Telephone Number 2. Non-US identification docurnent (e.g. tax certificate or 0 issued by the 7. Standing instruction to transfer funds ‘to an account maintained in the US . Power of Attorney or signatory authority granted to person with US Address; of “in care of” or “hold mail” address | | | 1. IRS Form W-8BEN; AND | | {government or an identification document based on KYC as approved by the 1S in the QI system) Any of the following: 1. IRS Form W-8BEN; OR 2, Non-US Identification document (e g, tax certificate or 10 issued by the government of an identification document based on KYC as approved by the 18S in |__ the qisystemn) + IRS Form W-9~ Request for Taxpayer Identification and Certification. Form W-9 is used by US person. + IRS Foirn W-8BEN - Cerificate of Foreign Status and Beneficial Owner of US Tax Withholding. Form W-86EN Is used by non-US person, meee med Have you stayed in the Philippines for an aggregate period of more than 180 days in any calendar year? (ves LINo Do you plan/intend to stay in the Philippines for an aggregate period of more than 180 days? Lives LINo ‘Ate you opening the account for the benefit or on behalf of another person? Lives LINo it yes, please provide name and relationship What is the reason for maintaining the account in your name? CEU ee By signing this form, I cetity that all information provided herein are true, accurate and complete, and I agree to inform the Bank of any changes relating to said information within 30 calendar days from the occurrence of such change. | expressly agree, consent, and authorize the Bank and/or its agents to process, obiain, collec, organive, stare, update, moity use, access, share, report and/or disclose ("Process"), whether manually or via electronic channels, without need of prior notice to me, any and all information relating to my Account(s) in order to comply with the (a) United States Foreign Account Tax Compliance Act (FATCA) as the same may be amended from time to time, (b) such other rules and regulations issued in connection with FATCA, and/or (¢) such other rules and regulations issued by the Bureau of Internal Revenue (BIR) and other governmental or regulatory agentes of the Republic of the Philippines. | further acknowledge that the Bank shall process, report and/or disclose information on the Account(s) on the basis of this Declaration and Authorization. For this purpose, I hereby waive my rights under confidentiality and data privacy laws of the Philippines, such as but not limited to, Republic Act (RA) No. 1405 (or the Law on Secrecy of Bank Deposits), RA No. 6426 (or the Foreign Currency Deposit Act of the Philippines) and RAA No. 8791 (or the General Banking Lew of 2000), RA No. 10173 (or the Data Privacy Act of 2012) as well as any applicable confidentiality and data privacy laws of foreign jurisdictions. in the event that (i) any information declared herein is found to be false, inaccurate, misleading or is no longer updated, oF (i) arm a US Person oF in case changes in circurnstances will ender and/or make me 2 US Person, | hereby undertake to promptly provide and/or update the correct required information to the Bank within 30 calendar days fram such change and, pursuant theteto, | ikewise authorize the Bank to process, report and disclose the required information to the intemal Revenue Services (1RS) and/or BIR. In consideration ofthe foregoing, | agree to hold the Bank, its directors, officers, employees, representatives free and agents free and harmless from any liability, actions, suits, costs and expenses arising frorn or in connection with the Bank’s.compliance with the FATCA regulations and/or as a result of disclosures made to the US 185 and/or the BIR. Customer's Signature over Printed Name: Signature verified by: ww (JC )- oo Law OOOO fina BANK'S ASSESSMENT OF CUSTOMER'S FAICA CLASSIFICATION: Customer is [JUS Person anume: JOD IOUIDO FNon-U5 Person Peon oenn | declare that the required account opening verification has been performed on the documents for the austomer/s listed chove, ond that the information provided is true, correct, and updated. officer's Name: Employee Number: Officers Signature sw (7-0 Chew O00