3/1/2019 BPI Express Online

BILLS PAYMENT ENROLLMENT FORM

3/1/2019 7:17:59 AM

Please enroll the following Payment Reference number/s:

Name : Princess Antonette Galvez De Castro

00000026540300
Account Number:

Company Name Account Name Acct/Ref No.

Philippine National Bank (PNB) Princess Antonette De Castro 5240466560287122

Important: Please affix all your possible signatures on the spaces provided below.

___________________________________ ___________________________________
EOL Client's Signature Over Printed Name EOL Client's Signature Over Printed Name

___________________________________ ___________________________________
EOL Client's Signature Over Printed Name EOL Client's Signature Over Printed Name

2. Please choose the method of enrollment most convenient to you:

1. Print, Sign and Mail to BPI

Steps:
1. Fill up the application form online.
2. Print the form and affix your signature on the space provided.
3. Mail the duly accomplished form to:

BPI Fulfillment Banking Group

9/F BPI Card Center
8753 Paseo de Roxas, Makati City 1200
Philippines

2. Print, Sign and Submit Form to Your Branch

Steps:
1. Fill up the application form online.
2. Print the form and affix your signature on the space provided.
3. Please submit the duly accomplished form to the branch where your account is based or to your branch of convenience (in the case of BPI Direct) for
processing of your enrollment.

3. Visit Your Branch

Steps:
1. Visit the branch where your account is based or your branch of convenience (in the case of BPI Direct).
2. Fill up the enrollment form available at the branch and sign the form in the presence of a branch personnel.
3. Submit the duly accomplished enrollment form for processing of your enrollment.

Submit & Print

https://secure1.bpiexpressonline.com/direct_signin.htm 1/1