‘Application No. Bhai ore Philippine Islands E-LINK ONLINE PAYMENT COLLECTION Customer Enroliment Form for Customers Depository Branch ‘Customer's Name Date Deposit Account Number to be debited (Customer Account ‘Company/ Merchant ‘Customer Reference No.* PRULIFE UK * Plaase see Custamer Reforance No. indicated on proof of bling, policy contract, or ‘customer intraductory letter to branch ‘TERMS AND CONDITIONS FOR ENROLLMENT UNDER BP''S ONLINE PAYMENT COLLECTION “The undersigned, hereby applies with the BANK OF THE PHILIPPINE ISLANDS (BPI) for enrolment under BP's Online Payment Collection ( Facil’) fr the payment of hisits bil via the automatic debiting of the BPI CA/SA Deposit Account as indicated above (the “Customer Account). For purposes of effecting payments fo the CompanyiMerchant through the Expresslink (Elink) System (the Faciity), the undersigned 41. Shall abide by the Bank's rules and requirements for maintaining the Customer Account and agrees to comply withthe Bank's rules and requirements forthe use of the Facity 2. Authorizes the Company/Merchant andior BPI to debit or cause the debiting of the Customer Account of amounts due to the CompanyiMerchant from time to tie, and thereafter, shall remit the same tothe Company/Meschant 3. Authorizes the Company Merchant or is agents to ‘know and access such information as may be required or necessary in the implementation of the Facity, such as but not imited to, existence and status of the Customer Account and reason for debit rejection, ifany, which information are or may be covered under R.A. 1405 (The Law an Secrecy of Bank Deposits). 4. Undertakes to ensure that the Customer Account shall alyays have sufficient and free funds to cover all amounts due as billed by CompanyiMlerchant Any discrepancy between the biled amount and the debited amount shall be resalved entirely between the lundersigned and Company/Merchant. 5. Acknowledges that bling and other complaints regarding the merchandise andior services ofthe Company/Merchant shal be the direct responsibilly of Company/Merchant and that BPI shall not, in any manner, have any ebligaton to the undersigned for matters relating to such complaints. 8. Agrees that his/ts enrolment under the Facity shall automaticaly be deemed withdrawn terminated at any time BPlis unable to {debt the amount due by reason of closure of isis Customer Account, insufficiency of funds, garnishment of deposit, or grounds analogous to the foregoing causes. The undersigned, on the other hand, may terminate hisits encliment inthe Facility by ‘submiting a wien notice of termination'cancellaio to BPI. The undersigned futher agrees that in case hisits enrollment in the Feacilty is cancellediteminated, hisits enrolment may only be reinstated upon the approval of Company/Merchant subject to the ‘same terms and conditions for new enrollees 7. For Corporate Customers: Represents and warrants that (a) All appropriate and necessary corporate and legal action has been taken by ito authorize the execution, delivery and performance of tnese terms and conditions and of the specific agreements tO which tis a party, and (b) These terms and conditions and such speeifc agreements to which it's a party constitu, and when ‘executed and delivered pursuant to these terms and conditions will constitute, ts legal, valid and binding obligations, enforceable In accordance with their respective term. There 1S no provision in its Arbcles of Incorporation, By-Laws or other constiutve documents of the undersigned, and no provision of any indenture or agreement to which fis a party or by which tor any ofits propery is bound, noris there any statue, rule or regulation, or any judgement, decree or order of any court or agency applicable {oi which would be contravened by the execution and delivery of these lenms and conditions or the specific agreements o which itis a party or by the performance of any provision, condition, covenant, or other term hereof or thereof 8. For Individual Customers: For joint accounts, its hereby understood and agreed that all ransactions to be made by any of the Uundersigned in connection with he Faciy are done wit the fll knowledge and consent of the undersigned s co-depositrls 8. Recognizes thatthe use of the Facity wil expedite payments of the undersignee's ebigations to the Company/Merchant and is {for the undersigned’s benefil and that of the Companyitiercant. 10. Holds BPI free and harmless from any and all damages, labilies, suits or causes of action arising from the implementaton/operation of the Faciy,foruitous events and any interruption, suspension or discontinuance of the Facilty due to technical or mechanical causes andi6r erors Cusiomer FOR BANK USE ONLY Encoded Vented by “Approved By.