CLIENT INFORMATION SHEET

DAT-F-SM-11 Rev.01 2018.Jan.15

Instructions:
Please write legibly and fill-up all information needed. Incomplete data will make this form invalid.

CLIENT INFORMATION:

Company Name : ________________________________________________________________________

Office Address : ________________________________________________________________________
Delivery Address : _______________________________________________________________________ _
Telephone Number(s) : _______________________________________Fax Number(s):_____________________
Web Site : ________________________________________________________________________
Owner : ________________________________________________________________________
Contact Person(s):
Name Designation Contact No. Email Address
1. ______________________________________________________________________________________
2. _______________________________________________________________________________________
3. _______________________________________________________________________________________

REGISTRATION and FINANCIAL STANDING:

Type of Business : Sole Proprietor Partnership Corporation
Nature of Business : Manufacturing Contractor (pls. specify _______________________________)
Distributor Others (pls. specify ___________________________________)

Tax Identification Number: _________________________ VAT Registration No.: ____________________________

Date of Registration : ___________________________________________
Bank and Financing Institutions
Bank Name Branch Type of Account Account No. Signatory
1. _______________________________________________________________________________________
2. _______________________________________________________________________________________
3. _______________________________________________________________________________________

Terms of Payment Request : _________________________________________

Credit Limit : _________________________________________
Authorized signatory of Purchase Order and Check:
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________

BILLING AND COLLECTION DETAILS:

Billing Documents Receiving

Invoice upon Delivery DR only upon Delivery DR & Invoice upon Delivery

Contact person to receive original Invoice: __________________________________________________________

Contact Number : ______________________________E-mail Add: __________________________
Invoice Countering Schedule : __________________________________________________________________
1
 Check/EWT Processing & Releasing

Contact Person : ________________________________________________________________________

Telephone No. : ____________________________________E-mail Add: __________________________
Check Releasing Date : ________________________________________________________________________
Department/Center : ________________________________________________________________________
Address : ________________________________________________________________________
Collection procedure details (Kindly indicate if there are other instructions, ex; attach original PO upon counter, cut-off, etc.)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Major Suppliers:
Company Name Contact Person Contact Nos. Product/Services Terms
Provided

PLEASE SUBMIT THE FOLLOWING DOCUMENTS: Basic Requirements (Photocopy)

1. Accreditation Form
2. Business Permit / Mayor’s Permit
3. BIR Certificate of Registration
4. DTI Permit / SEC Certificate
5. Photocopy of I.D of signatory

Note: Should you have other information to declare which you deemed relevant to be taken into account in our
evaluation, please free to use another sheet.

I confirm that the above information given is true, correct and complete.

Name and Signature of Authorized Person Designation Date