SAGIP LENDING INC.

Zone 3 Tallang, Baggao, Cagayan

Contact No. 0917-1145-945

CLIENT INFORMATION SHEET

CLIENT’S NAME:
PRESENT ADDRESS:
PERMANENT ADDRESS:
MOBLIE NUMBER: SOURCE OF FUNDS:
 Salary/Wage/Commission
DATE OF BIRTH:
 Regular Remittance Allowance
PLACE OF BIRTH:  Retirement/Pension Fund
 Bank Deposits/Placements/Investments
NATIONALITY:
 Others______________________________
ID PRESENTED:
ID NUMBER: EMPLOYMENT STATUS:
 Employed
BENEFECIARY DETAILS
Name of Employer: ________________________
Name: Nature of Work: ________________________
Present Address:
Date of Birth:  Self Employed
Name of Business: ________________________
Place of Birth: Nature of Business: ________________________
Source of Funds:
 Unemployed
Nature of Work
ARE YOU A GOVERNMENT EMPLOYEE?
 YES
 NO
If yes indicate the position and Office:________________________________________

DO YOU HAVE IMMEDIATE RELATIVE WORKING IN THE GOVERNEMENT?

 YES
 NO
If yes, Name of Government Employee: ___________________________________________
Position and Office: __________________________________________________
Relationship:
 Spouse
 Child
 Parent
 Sibling

DATA PRIVACY AGREEMENT AND CLIENT CONSENT DECLARATION

I understand that the information collected, to be processed and retained shall be for the following purposes; client identification; profiling; direct marketing
and cross selling of products: and compliance to BSP rules, AMLA and such other purposes that may be required or allowed by law. I have been inform that I
have the option not to give the foregoing information, in which case I understand that my transaction will not be processed. I have also been informed that I
can make corrections to any inaccurate or deficient information and that I have an option to withdraw my consent prior to the processing of my transaction
by emailing SAGIP LENDING INC., at ups_baggaobranch@yahoo.com or calling at Cellphone number 0917-1145945.

I hereby certify that the foregoing information are freely and voluntarily given and are true and correct to the best of my knowledge. Further, I hereby
authorize SAGIP LENDING INC., to disclose to its partners, agents or other clients my above information to aid in any and all investigations that may be
initiated on account of, or in relation to any concerns that may arise out of this transaction.

__________________________________________ __________________________________________
CLIENT SIGNATURE OVER PRINTED NAME VERIFIED BY AUTHORIZED PERSONNEL
 SAGIP LENDING INC.
Zone 3 Tallang, Baggao, Cagayan
Contact No. 0917-1145-945