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PNB Customer Information Form Individual
PNB Customer Information Form Individual
F O R B A N K U S E O N LY
DATE 3. PLEASE INFORM THE BANK FOR ANY CHANGES IMMEDIATELY.
M M DD YYYY
Last Name, First Name, Middle Name Last Name, First Name, Middle Name
CUSTOMER NAME:
Number/Street, Barangay/Subdivision, City/Municipality, Province/State
SSS / SSS UMID GSIS Driver’s License Passport Others (pls. specify)
Nationality Citizenship
Employment Information
CUSTOMER ID NUMBER:
E-Mail
Number Country Code Area Code
Source of Funds
Average Monthly Amount
Salary Pension Allotment Remitter’s Name Relationship
Business Donation 1)
Commission Gaming
2)
Property Financial Products
US F ATCA
NO but with US indicator YES (Please fill out the Consent & Authorization for
Are you a U.S. person? N.A. US Persons under US FATCA and W9 Forms)
(please fill out the W8-BEN Form)
Are you interested to avail of the products/services below?
2. acknowledge to have read, understood, agreed and received the Terms and Conditions Governing the Opening and Maintenance of Accounts,
including those on Data Privacy, which was presented to me upon opening of the Account and which can be accessed in PNB’s website
www.pnb.com.ph as well as other terms and conditions governing deposit products, services and/or facilities that I availed or will avail in the
future; and
3. acknowledge that the terms and conditions referred to above may be amended from time to time.
___________________________________________________________
Signature Over Printed Name of Depositor / Date Form No. NA001..3 Aug. ‘21
For Bank’s Use Only
Other IDs Presented:
Customer Walk-in Solicited Account Solicited By: ____________________________________
Signature Over Printed Name / Date
Contact:
Referred Name of Referror / Relationship: ______________________________
____________________________________ ____________________________________
Signature Over Printed Name / Date Signature Over Printed Name / Date
Verified Against CWS, OFAC & Signature Authenticated by: Approved by:
Documents Verified Against Original by: