LAND BANK OF THE PHILIPPINES

Branch

weAccess ENROLLMENT AND MAINTENANCE AGREEMENT FORM

(Viewing Facility only)

New Enrollment Update Enrollment

INSTITUTION PROFILE
Name of Institution Short Name

Address ZIP Code Country

No. Street Barangay/District Municipality/City Province

Contact Number Fax Number Tax Identification Number (TIN) Date of Incorporation
- - - - -
Area Code Telephone Number Ext. Area Code Telephone Number M M D D Y

BIR Registered Name Institution's Email Address1/ Client Type2/

SUBSIDIARIES
INSTRUCTIONS INSTITUTION NAME TAX IDENTIFICATION NUMBER (TIN)

Add Delete - - -

Add Delete - - -

ACCOUNT ACCESS PROFILE

INSTRUCTIONS ACCOUNT TAG3/ ACCOUNT NUMBER

Add Delete -

Add Delete -

Add Delete -

Add Delete -

Add Delete -

CHARGES (if any)

Total Number of weAcess USB/flash disk: Total Billing:
Cost of weAccess USB/flash disk in excess of three (3)
Cost of weAccess USB/flash disk Replacement
Cost of weAccess vToken Application

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility - Account Information module. I/We hereby acknowledge to have read, understood an
the Terms and Conditions of the LANDBANK weAccess facility.

Signature over Printed Name of Authorized Signatory/ies Date

FOR BANK USE

SERVICING BRANCH/EO SYSTEMS IMPLEMENTATION DEPARTMENT
Reviewed by Verified by Approved by Checked by Enrolled by Date

Distribution Copy 1 - SID Copy 2 - Institutional Client Copy 3 - Depository Branch

of Incorporation

Y Y Y

ATION NUMBER (TIN)

COUNT NUMBER

dge to have read, understood and agreed to be bound by

ARTMENT
Date
Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) Please use additional sheets, if necessary.

1/ The designated email address where notices from the weAccess Facility shall be sent.
2/ e.g. GOCC, NGA, LGU, Private Corporation, Partnership, Cooperative, SME, Educational and Health Institution, Development Partnet, Religious and
Charitable Organization, Commercial/Universal Bank, Thrift Bank, Rural Bank, Other Financial Intermediary, NGO/People Organization/Association,
Micro-Enterprise, Sole Proprietorship
3/ The designated account description with a maximum of 15 alphanumeric characters (e.g. Payroll Account).

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after the last item.

pment Partnet, Religious and

e Organization/Association,

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 LAND BANK OF THE PHILIPPINES
Branch

Name of Institution Short Name

USER PROFILE
Name

First Name Middle Name Last Name

Address ZIP Code Country

No. Street Barangay/District Municipality/City Province

Position/Designation Date of Birth E-mail Address
User ID Position/Designation Gender Male Date of Birth

Female - -
M M D D Y Y Y Y
vToken ID Contact Number/s Civil Status Tax Identification Number (TIN)
Landline Mobile
Single Divorced - -
Challenge Questions Married Separated FOR BANK USE ONLY
1. Mother's Complete Maiden Name Widowed Internet Password Mailer ID
2. Name of High School - - -
3. Grandfather's Name
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)

Add Maker Account Information Fund Transfer Current Account Services

Delete Authorizer - - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)

Add Maker Account Information Fund Transfer Current Account Services

Delete Authorizer - - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)

Add Maker Account Information Fund Transfer Current Account Services

Delete Authorizer - - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)

Add Maker Account Information Fund Transfer Current Account Services

Delete Authorizer - - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)

Add Maker Account Information Fund Transfer Current Account Services

Delete Authorizer - - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)

Add Maker Account Information Fund Transfer Current Account Services

Delete Authorizer - - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
 Country

ication Number (TIN)

BANK USE ONLY

Password Mailer ID

able modules)

Current Account Services

able modules)

Current Account Services

able modules)

Current Account Services

able modules)

Current Account Services

able modules)

Current Account Services

able modules)

Current Account Services

 ACIC File Upload

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

Signature over Printed Name of User Signature over Printed Name of Authorized Signatory Date

FOR BANK USE

SERVICING BRANCH/EO SYSTEMS IMPLEMENTATION DEPARTMENT

Reviewed by Verified by Approved by Checked by Enrolled by Date

Distribution Copy 1 - SID Copy 2 - Institutional Client Copy 3 - Depository Branch

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) User ID must be composed of 6-8 alphanumeric characters, letters using upper cases only. The number zero should be written as "Ø"
to differentiate from the letter "O".
(3) Vtoken ID must be composed of 8 alphanumeric characters. The number zero should be written as "Ø" to differentiate from the letter "O".
1/ Authority of the designated user.
2/ Fund Management includes Auto Crediting, Auto Debiting and Fund Sweeping Modules.
d agreed to be bound by

Date

DEPARTMENT

ould be written as "Ø"

ntiate from the letter "O".

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