BDO Auto-Debit Arrangement Enrollment Form Authority to Debit (Individual / Corporate) How to enroll / update enrollment + Read the Terms and Conditions at the back of this form. - Fields with an asterisk (*) are required, + Complete and sign this form and, submit it to your maintaining branch, 4. Customer Information Accountname” Please chock: [Individual] Corporate Address® Please chock []Residence [] Business Contact persons" Tel. No. (residence) Tal. No. (business)* Fax No* 2. Customer Payee List Information 4. Indicate the folowing: “E* for enrll- first ime ADA setup with payee or reenroliment. “D'or delete - any change in debit account number / change in subscriber number / change in subscriber name | voluntary cancellation termination af ADA with payee. 2. Please enumerate the payee!s thal you would lke to enrol oF delete for aulodebit arrangement (ADA). 3. Indicate your subscriber number with hat payoetotner subscriber number's you wish to enrol or delete ag. account numbar, service LD. number, policy number membership number 4. Indicate your subscriber namefather subscriber names you wish to enroll or delat 5. Indicate your detault bank account number from which funds will be automatically debited in sottioment of your payabies tothe payee’ once a collection instruction / bling fle is Sont to the Bank by the payeets. This may be changed later f cesired. eo" Poy Name? ‘Subserber Number Subsribr Name! nr abit Account Not # Declaration |e have read and agree tothe ADA terms and conditions printed at tre back ofthis form, We dectare tt the above information are accurate tommy four knowledge. All Required Signatories Signatory ‘Sonstory2 Signatory 5 (Signature oer pried name) (Senate over printed name) (Signature ver printed name) For Bank Use Only. Branch HG. Unit Signatures Verified by: Processed by: {signature over prio name) (signature ovr printed namo) ‘Da and Tine Date ang Tine: ValidatediApproved by: ‘CheckediAppraved by: {signature ovr printed nama) (Gienatre ovr printed namo) ‘to and Time ‘Dato and Timo‘Auto-Debit Arrangement (ADA) Terms and Conditions, Date of Enrollment To BANGO DE ORO UNIBANK, INC. BDO Corporate Center, 7899 Makati Ave, Makati City Gentlemen: “This wil serve as your authorization to debit mylour enrelled accounts to settle myfour billings in favor of mylaur enrolled payeels under the AUTOMATIC DEBIT ARRANGEMENT ("ADA’). Mylour ADA enrolled accounv’s and corresponding payae!s are indicated on the reverse side hereof In this regard, IWe hereby agree to be governed by the following ADA terms and coneditions 4. Banco De Oro Unibank, In.("800") and myfour payee!s have entered into a Memorandum of Agreement ("MOA") whereby BDO wil factitate the collection of my/our payeo's/s' billings to metus, via auto-debit from mylour enrolled accounts 2. We hereby expressly authorize BDO's unit-n-cherge of implementing the collection, to automatically debit from time to tine, without need of ‘any further act and deed, from mylour enrolled accounts, the amounts due to myfour payee!s as described in the collection instructionvbiling file as may be transmitted by mylour payeels to BOO from time to time in accordance with tarms of the MOA. Amounts debited from mylour trolled accounts willbe automatically credited to mylour payee'sls' eposit accounts with BDO. Its agroed and understood that in case the cleared and withérawable balance of mylour enrolled accounts be insufficient to pay in fll the ‘otal amount due to mylour payeels, BDO shall net effect partial payment thereof out ofthe insuficient balance of myfour enrlled accounts. 3. Any claim which may arise from any diserepanay between the amounts debited from mylour enrolled accounts and that tated in mylour ‘payee'si’ collection instruction/iling file shall be resolved with mylour payee, 4, Payments for past due or overdue accounts with service disconnectiontermination or poleyicontractlapsation shall be made directly to the collection offices of mylour payee. Payment procedures/stioulations imposed by mylour payeels not inconsistent herewith or with any terms anc conditions hereof or any related ‘documents or instruments executed by BDO and the undersigned or any of us, are deemed incorporated herein by way of reference. 5. For enrolled joint “or” accounts, lave hereby agree and! understand that any and all ransaction done by me/usfany of us through the ADA are done with the consent of all of mylour codepositorls Further, Iiwe hereby declare under the penalties of perjury that all of mylour ‘co-depositorsislare ving atthe time af such transactions. 6. For enrolled corporate accounts, Ive hereby agree that the ADA transactions are authorized by mylour company’s board resolution covering rmylour account maintenance with B00. 7. Ue hereby agree to waive a separate notice af debit ether than that refleced in BDO's passbook or bank statement. 8. [Mie hereby agro o reimburse and forever hold BDO, its directors, officers, employoes and assigns, free and harmless from any and all claims, ‘actions, andlor labilies of whatever kind and nature, for checks drawn against myfour enrolled accounts but returned fdshonored as a result, ‘of the debit of the amounl’s due to my/our payeels from myour enrolled accounts; andlor arising aut of or in connection with the Implementation of this ADA, andlor for BDO's failure to implement this authority due to erroris and omissions inadvertently committed, 8. Ie hereby expressly waive mylour rights under the Secrecy of Bank Deposits Law (R.A, 1405) in connection with any information which may bbe disclosed by BDO to mylour payee! from time to time and as may be necessary to implement the MOA between BDO and myiour payeels For this purpose, lwe hereby authorize BDO to disclose myfour payee!s any information pertaining to mylour enrolled accounts, as may be necessary forthe implementation f this ADA. 10, BDO reserves the right to impose charges on this arrangement within logal/statutory limits 11, The MOA botwoon BOO and mou payels may be canceled at anytime by ler party wihout need of ror writen notice of termination tome 12, This ADA shall be governed by all applicable rules and regulations of the Bangko Sentral ng Pilipinas, Phippine Clearing House Corporation| ‘and other relevant government agency. 13, Allterms and concitions of myfour existing savings/current account agreements wth BDO in so far as not inconsistent herewith shall remain In full force and effect. 114, This ADA shall take effect after BDO receives confirmation of mylour ADA enrellment from myour payeels following the date of enraliment: Indicated above and shall continue tobe effective unless otherwise notified by mefus in wring BDO at least seven (7) days prior to intended {ate of termination. BDO however, may immediately terminate this Agreement without notice to metus, in case live mishancle myfour enrolled ‘sccountés inthe reasonable determination of 800. 16, This ADA and the implementation of the terms hereor shall be subject to Ue pertinent provisions of the MOA betwaen BDO and mylour payools as wall as BDO’ Implementing Guidoines, which are devmed incorporated herein by way of reference.