TMP-XT-18-18

APPLICATION FOR MC/ DD/ TT/ FCY

Reference No.
To: UnionBank of the Philippines Branch/Unit: Date: (For Bank Use Only)

Please fill out pages 1 and 2 completely. Applicant Type: Individual Corporate/ Other Entity
APPLICANT INFORMATION
NAME (Last Name, First Name, Middle Name) REQUEST FOR
Manager's Demand Telegraphic FX FX
Check Draft Transfer Purchase Sale
ADDRESS

TELEPHONE NO. FAX NO. EMAIL ADDRESS

APPLICATION DETAILS
AMOUNT APPLIED FOR IN WORDS CURRENCY
3rd Currency
PHP USD Pls. specify

AMOUNT APPLIED FOR IN FIGURES EXCHANGE RATE MODE OF PAYMENT

Cash Debit to ACCOUNT NO.

APPLICATION TO PURCHASE FOREIGN EXCHANGE *

RESIDENCY SSS / GSIS / VOTER'S ID NO. / DRIVER'S LICENSE NO. TIN
(For Individual; please underline ID used)
Resident Non-Resident

PURPOSE OF PURCHASING FOREIGN EXCHANGE* (Please check appropriate box)

Trade (payment for importations) Issued by other residents: Others
1 2
Inward Foreign Investments by Non-Residents Please specify: Services
Repatriation of Capital Held for sale/ trading by banks operating in the Others,
Philippines, regardless of issuer
Remittance of Profits/ Dividends/ Earnings (Please specify) 4
Foreign currency loans owed to banks operating
Remittance in FX equivalent of peso funds
in the Philippines (FCDUs/ EFCDUs/RBU) Non-merchandise Insurance
(funded by FX remittance) in excess of
investments made in the Philippines Prepayment
Premiums
Regular Payment
Outward investments by Residents: Claims/payables
Principal
Direct Investment (Equity Capital) Passenger Tickets
Interest
Debt Securities Travel Expenses
Equity Securities Fees
Commissions
Mutual Funds (MFs)/ Others (Please specify) Professional/Management Fees
Unit Investment Trust Funds (UITFs)
3 Royalties
Intercompany Loans Foreign Loans 5
Income Payment
Purchase of real property abroad, including Owed to Non-residents
condominium units Transfers (e.g. grants, donations)
Foreign currency-denominated investment Owed to Offshore Banking Units Conversion to foreign exchange of peso
intruments issued onshore by non-residents Prepayment deposit accounts of non-residents

Resident to resident transactions: Regular Payment

Obligations payable to residents Principal

Resident investments in instruments (including time Interest

deposits with at least 90-day maturity but excluding Fees
other bank deposits such as savings and demand):
FOREIGN EXCHANGE DISPOSITION (Please check appropriate box)
CASH FOR DIRECT REMITTANCE FOR CREDIT TO FCDU ACCOUNT (SA, TD)
Full, Amount: Account No.

Partial, Amount: Full, Amount:

Balance to be remitted/ Partial, Amount:

on or before (Required):
Balance to be remitted/
on or before (Required):
DESIGNATED BENEFICIARY DETAILS (Required to be filled out except for travel purpose, medical expenses not yet incurred and sales proceeds of emigrant's
domestic assets if emigrant is still in the country)
NAME (Last Name, First Name, Middle Name) ACCOUNT NO

ADDRESS BANK

I hereby certify that:

a. No double purchase of FX has been made on spot basis and/or via derivatives contracts covering the same underlying transaction;
b. The FX purchased shall be used for the declared purpose and funds credited to the purchaser's FCDU account shall eventually be remitted to the intended
beneficiary, on or before due date;
c. As FX purchaser, I will disclose to the remitting bank the intended purpose of remittance;
d. FX purchases shall not be made to circumvent regulations on FX transactions;
e. All applicable laws, rules and regulations covering the declared FX transaction are complied/ shall be complied with.
f. Pertinent documents shall be made available upon request by the Bangko Sentral ng Pilipinas for post-verification; and
g. The information disclosed in this application form are, to the best of my/our knowledge and belief, complete, true and correct, and that the declaration is
made in good faith.

Signature of Applicant or Authorized Signatory/ies over Printed Name Date

Page 1 of 2
*1
To be accomplished for each purpose to which FX shall be purchased from AABs/AAB-forex corps. Scanned copies of the original duly accomplished signed application form may
also be submitted. AABs/AAB-forex corps shall make the submitted forms available upon request by the BSP for post-verification.
2
For BSP-registered loans/investments
3
Loans of residents to offshore parent companies/subsidiaries of residents with an original tenor of at least one (1) year
4 Such as Communication, Manufacturing, Maintenance and Repairs, Postal and Courier, Computer and Information, Research and Development, Advertising, Market Research,
Technical, and other Business Services
5
Other than those related to loans and investments Revised February 2018
 APPLICATION FOR MANAGER'S CHECK / DEMAND DRAFT/ TELEGRAPHIC TRANSFER / FX SALE
PURPOSE FX CONVERSION PROCEEDS
Cash Credit to ACCOUNT NO.
BENEFICIARY DETAILS
BENEFICIARY NAME/ PAYEE BENEFICIARY ACCOUNT NO. (For TT Only)

BENEFICIARY ADDRESS (For TT Only)

BENEFICIARY BANK DETAILS (For TT Only)

RECEIVING BANK INTERMEDIARY BANK

BANK NAME

SWIFT CODE/ ROUTING NO.

ADDRESS/REF. NO.

OTHER INSTRUCTIONS

DEBIT AUTHORIZATION
The application is subject to the conditions below to which I/we agree.If payment is to be debited from a deposit account, this will authorize the Bank to debit
my/our account for the payment of the MC / DD / TT / FCY including Bank charges. Further, I/We declare under the penalties of perjury that my/our co-
depositors is/are still living.

For authorized representative/s only:

This will authorize whose signature appears below, to acknowledge receipt of the
above instrument. This will further hold the Bank free and harmless from any liability whatsoever that may arise in the event of any loss or unauthorized
negotiation of the instrument.

Signature of Applicant or Authorized Signatory/ies over Printed Name Date Signature of Authorized Representative/s over Printed Name Date

FOR BANK USE ONLY MC /DD / NOTES RECEIVED BY

PROCESSED BY APPROVED BY

Signature over Printed Name Date Signature over Printed Name Date Signature of Applicant or Authorized Date
Representative/s over Printed Name

TERMS AND CONDITIONS

CONDITIONS ON FUND TRANSFER / PAYMENT

UnionBank of the Philippines ("the Bank") will take the customary steps in the fund transfer / payment subject of this
Application. The Bank is free to make use of any correspondent, sub-agent or any other agency, but in no case shall the
Bank or any of its correspondents be liable for mutilations, interruptions, omissions, errors, non-transmission, or delays
occurring in the mails, or on the part of any telegraph, cable, or wireless company, or any employee of such company, or for
any reason or cause whatsoever beyond the control of the Bank or its correspondents / agents.
The Bank may send any message relative to this fund transfer / payment in explicit language, codes or ciphers and shall not
be liable for errors, neglects or defaults of its correspondents, sub-agents, or other agency.
Any draft issued will be advised immediately to the drawee. The drawee will not be responsible should the draft be
dishonored as a result of delay in presentation or late arrival or non-arrival of advice of the drawing or for any other reason
beyond the drawer's control.
The Client - Applicant assumes / accepts full responsibility for fraudulent or erroneous instructions provided that the Bank has
complied with the terms and conditions set forth in this application.
CONDITIONS ON FOREIGN CURRENCY REMITTANCES
Unless it is otherwise expressly agreed in writing, the Bank may, at its discretion, convert into foreign values the funds
received from the Applicant at the Bank's selling rate on the day such funds are received. The Bank's statement in writing
that it has effected such conversion shall be conclusive for all intents and purposes.
CONDITIONS ON ISSUANCE OF MANAGER'S CHECKS / DEMAND DRAFTS
If the Manager's Check (MC) or Demand Draft (DD) is lost, stolen, or destroyed, the Applicant shall provide the Bank with a
bond indemnifying the Bank against any and all liability whatsoever with respect to the lost, stolen, or destroyed MC / DD as a
condition precedent for the replacement by the Bank of such lost, stolen, or destroyed MC / DD issued by the Bank. MC's
however, shall not be subject to Stop Payment in case of loss.
The Client - Applicant assumes / accepts full responsibility for Manager's Checks issued in favor of Government Offices
provided that the Bank has complied with all the requirements in processing such a transaction.
The Client - Applicant shall also assume / accept full responsibility for fraudulent or erroneous instructions relative to the MC /
DD issuance provided that the Bank has complied with the terms and conditions set forth in this application.

Page 2 of 2

Revised February 2018