New Customer Customer Records Update (for existing SMART customers)

BUSINESS CUSTOMER INFORMATION FORM

To be filled out by the Customer
Date Accomplished/Signed:
BASIC CUSTOMER INFORMATION
Registered Business Name: Life Style Korea Corporation Main Telephone No./Trunkline:
Fax No.:
Customer's E-mail Address: lskcorp.2022@gmail.com
Store/Shop/Outlet Name/Trade Name: Life Style Korea Corporation Website:
Business Address: Mac Arthur Highway, San Rafael, Tarlac City, Tarlac 2300
Billing Address (if different from Business Address):

Names of Bill Recipients 1 . Angela L. Trinidad 2 .RO-AN T. Chin

Contact numbers of Bill Recipients 1 . 09152232005 2 . 09664737605
Email Address of Bill Recipients 1 .aljhen_2205@yahoo.com 2 .roanchin1210@gmail.com
Finance Officer : Finance Officer Contact Number: Finance Officer's Email Address:
Business Ownership: x Private Government
Tax Class: VAT Exempt/ Zero-Rated x With VAT Others, please specify
SEC Registration No. 2022080065068-00 Company TIN:

Industry Type :Wholesale Please specify: Wholesale of household goods

AUTHORIZED SIGNATORY INFORMATION

Name of Authorized Signatory: Position and E-mail Address: Contact No.[Landline No. & Mobile No.]
Angela L. Trinidad aljhen_2205@yahoo.com 09152232005
ID Presented:
Company ID; ID No. Passport; ID No. Others ; ID No.
Driver's License; ID No. SSS/GSIS ID; ID No.
ORGANIZATION DATA
Type of Business (Check only one) SINGLE PROPRIETORSHIP PARTNERSHIP x CORPORATION
Date of Registration: No. of Employee(s)/Staff: Years in Operation:
FOR CORPORATION
Key Officers ( indicate the name and position/designation) Contact No. Email Address
Angela L. Trinidad/ President 09152232005 aljhen_2205@yahoo.com
RO-AN T. Chin/Secretary 09664737605 roanchin1210@gmail.com
Ma. Cindy F. Liwanag/Treasurer 09926093818

FOR PARTNERSHIP - Name of Partners

Name and Position/Designation Contact No. Email Address
1.
2.
3.
FOR SOLE PROPRIETORSHIP
Name of Owner : Date of Birth:
SSS No.: Personal TIN No.: Telephone No.:
Home Address:

FAX No.: Mobile No.: Email Address:

BILL DELIVERY AGREEMENT
YOUR ACCOUNT WILL BE AUTOMATICALLY ENROLLED IN PAPERLESS BILLING AT THE EMAIL ADDRESS YOU PROVIDED.
I/We acknowledge that PLDT/Smart shall send us our Bill within 8-10 calendar days after the Bill Date via electronic mail (email) through the email address I/we specified in this form. PLDT/Smart is deemed to
have validly sent the Bill, and the Bill shall be deemed received at the email address I provided PLDT/Smart. I/We agree to hold PLDT/Smart free and harmless from any liability for my/our failure to receive the
Bill despite it being sent to my/our email address. By Agreeing to receive our Bill via email, I/we understand that I/We will no longer receive a printed copy of my/our bill. Should I/we opt to receive a
printed copy of my/our bill, I/we will course my request through any of the following channels: For PLDT - PLDT Hotline by dialing 177, PLDT Enterprise Facebook, pldtent_cares Twitter account or
enterprisecare@pldt.com.ph email. For Smart - enterprisesupport@smart.com.ph or EnterpriseBro@smart.com.ph email.

SOLE PROPRIETOR DISCLOSURE

My signature below signifies that
1. I hereby authorize PLDT INC. and/or any person authorized by PLDT to obtain relevant and pertinent personal information about myself and credit information from the PLDT Group, it's subsididaries, affiliate banks,
credit card companies, and other financial institutions in the course of evaluating my application, and I authorize the release of such information by these companies from which my personal data and credit information are
requested. I also consent to PLDT's disclosure of information concerning myself or my subscription to these companies. I acknowledge that a complete list of the entities under the PLDT Group can be accessed by myself
on the PLDT website [ http://www.pldt.com/privacy-policy ]

2. I also hereby authorize PLDT to use and disclose to the PLDT Group and Its subsidiaries and its authorized business partners all information contained in this application including supporting documents submitted, as
well as all information in connection with my subscription, my network/service usage and connections including data about the device/e I use to connect to your service, my payment history/behavior with respect to my
subscription, and all information about myself from your advertisers and business partners, for purposes of (a) facilitating my application for services which they offer; (b) product and service improvement being offered to
me by PLDT Group and its subsidiaries and its authorized business partners; (c)advertising new products and services being offered by PLDT Group and its subsidiaries and its authorized business partners; (d) credit
investigation and establishing my credit worthiness; and(e) improving customer experience.

I hereby declare that all the above information are true and correct to my own knowledge. I hereby authorize PLDT/SMART/SUN to verify any of the above
given information from whatever source it may consider appropriate. Any misrepresentation on the above information shall constitute a just cause for the rejection of
my application or the termination of my contract with the Company.

Authorized Signatory/Signature above Position Date

Printed Name
BCIF_ver9 with DPA and Bill Delivery Agreement _02022022
 TO BE FILLED OUT BY PLDT/SMART/SUN AUTHORIZED SALES PERSONNEL
DOCUMENTARY REQUIREMENTS
Please check compliance of documents based on the type of business (Corporation, Partnership, Sole Proprietorship)
CORPORATION PARTNERSHIP SOLE PROPRIETORSHIP

Accomplished Business Customer Information Accomplished Business Customer Information Form Accomplished Business Customer Information Form
Form
Business Permit/Mayor's Permit
Corporate Secretary Certificate or Notarized
Notarized Authority from the Partners
Board Resolution (indicating name of authorized Special Power of Attorney - if the
(indicating the authorized signatory to sign/transact
signatory to sign/transact busines with PLDT in document/conforme is not signed by the owner
business with PLDT in behalf of the partnership).
behalf himself
of the company)

Photocopy of Valid ID with signature of Photocopy of Valid ID with signature of Photocopy of Valid ID with signature of
authorized signatoryValid ID's: Passport, Driver's authorized signatory Valid ID's: Passport, Driver's owner/proprietor. Valid ID's: Passport,
License, SSS, GSIS, TIN, PRC License (any 1) License, SSS, GSIS, TIN, PRC License (any 1) Driver's License, SSS, GSIS, TIN, PRC
License (any 1)
ADDITIONAL REQUIREMENTS FOR CORPORATION/PARTNERSHIP/SOLE PROPRIETORSHIP, IF APPLICABLE
NTC Certificate of Registration [For Internet Service Providers, Cable TV Operators, Broadcast Networks, Telecom Companies, Value Added Services and Content
Providers]

Tax Exemption Certificate. (For companies situated in ECOZONES, qualified Embassies and respective qualified diplomats, Foreign administrations, BOI, PEZA,
SUBIC, CLARK registered entities. For companies claiming for tax exemption, additional documents are: BIR Form 2303, BIR Form 0605 (current year), PEZA
Certificate of Tax Exemption (current year)

SEC Form F-104/F-108 for Foreign Corporation (in lieu of Articles of Incorporation)

Proof of Billing Address, any utility bills. (Only required if billing address is different from the business address and site address )
ADDITIONAL REQUIREMENTS FOR GOVERNMENT AGENCIES
Executive Order or Republic Act stating the creation of the particular agency

General Order [for military agencies] or Letter of Instruction

Appointment papers and photocopy of ID of the authorized signatory

Certification of Funds or Budget allocation for Communication Expense

SERVICE REQUEST DETAILS
TYPE OF SERVICE (Proposed service) QUANTITY Estimated Monthly Recurring Charge (MRC) - VAT
Exclusive
PHP USD

1.
2.
TOTAL =

CERTIFICATION [To be filled out by Authorized Sales Personnel]

TO FOLLOW DOCS Deviation Request [please indicate justification]
Deferment of Document
To be submitted on or before : Bill Above Await Payment
submission Reduction of Advance Payment
I hereby declare and certify that all the above information and documents submitted are validated true and correct. Likewise, I am vouching the authenticity and legal existence
of above mentioned customer and that the person who signed the BCIF/Contract/Conforme/Service Application Form is the designated authorized signatory of the said business
entity.

Submitted/Vouched by: Noted by:

(Sales Personnel) (Sales Head)
PLEASE SIGN OVER PRINTED NAME PLEASE SIGN OVER PRINTED NAME
Date: Date:

SALES TEAM :
CUSTOMER NAME:
FOR CREDIT USE ONLY
Approved Disapproved
Amount of Advance Payment required: Notes :

Evaluated by: Date:

Credit Analyst (Sign over printed name)
BCIF_ver9 with DPA and Bill Delivery Agreement _02022022

BCIF_ver5
_07292015
Reduction of Advance Payment (for CBG only)