CLASS D

LAND BANK OF THE PHILIPPINES

Roxas (Capiz) Branch

weAccess ENROLLMENT AND MAINTENANCE AGREEMENT FORM

(Viewing Facility)
/ New Enrollment Update Enrollment Delete Enrollment

INSTITUTION PROFILE
Name of Institution Short Name
AGBALO ELEMENTARY SCHOOL AES

Address ZIP Code Country

AGBALO PANAY CAPIZ 5801 PHILIPPINES
No. Street Barangay/District Municipality/City Province
Contact Number Fax Number Tax Identification Number (TIN) Date of Incorporation
09985470887 - - - - -
Area Code Telephone Number Ext. Area Code Telephone Number M M D D Y Y Y Y

BIR Registered Name Institution's Email Address1/ Client Type2/

SUBSIDIARIES
INSTRUCTIONS INSTITUTION NAME TAX IDENTIFICATION NUMBER (TIN)
- - -

- - -

ACCOUNT ACCESS PROFILE

INSTRUCTIONS ACCOUNT TAG ACCOUNT NUMBER
Add AGBALO ELEMENTARY SCHOOL 0472 - 1261 - 05

- -

- -

- -

- -

CHARGES (if any)

Total Number of weAcess USB/flash disk: Total Billing:
Cost of weAccess USB/flash disk in excess of three (3)
Cost of weAccess USB/flash disk Replacement
Cost of weAccess vToken Application

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

MARY ANN M. ROXAS

Signature over Printed Name of Authorized Signatory/ies Signature over Printed Name of Authorized Signatory/ies Date

FOR BANK USE

SERVICING BRANCH/EO SYSTEMS IMPLEMENTATION DEPARTMENT

Reviewed by Verified by Approved by Checked by Enrolled by Date

Distribution Copy 1 - SID Copy 2 - Institutional Client Copy 3 - Depository Branch

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) Please use additional sheets, if necessary.

1/
The designated email address where notices from the weAccess Facility shall be sent.
2/
e.g. GOCC, NGA, LGU, Private Corporation, Partnership, Cooperative, SME, Educational and Health Institution, Development Partnet, Religious and
Charitable Organization, Commercial/Universal Bank, Thrift Bank, Rural Bank, Other Financial Intermediary, NGO/People Organization/Association,
Micro-Enterprise, Sole Proprietorship
3/
The designated account description with a maximum of 15 alphanumeric characters (e.g. Payroll Account).
page 1
CLASS D
 CLASS D

Add
Delete

000
Agoo GOCC 0 001
Alabang Business Center NGA 1 002
Alabel LGU 2 003
Alaminos Private Corporation 3 004
Alicia Partnership 4 005
Allen EO Cooperative 5 006
Almanza SME 6 007
Angeles Educational and Health Institution 7 008
Antipolo Development Partner 8 009
Antique Religious and Charitable Organization 9 010
Apalit Commercial/Universal Bank 011
Aparri Thrift Bank 012
Araneta Center EO Rural Bank 013
Baclaran Other Financial Intermediary 014
Bacolod City NGO/People Organization/Association, 015
Baguio Micro-Enterprise 016
Baguio Naguilian Sole Proprietorship 017
Bais 018
Bajada 019
Balagtas 020
Balanga 021
Balayan 022
Baler 023
Baliuag 024
Bambang 025
Bangued 026
Banilad EO 027
Bansalan 028
Basco 029
Basilan 030
Batac 031
Batangas City 032
Batangas City PPA EO 033
Batasan 034
Bauan (Batangas) 035
Bayawan 036
Baybay 037
Bayugan 038
Bicutan DOST 039
Binalonan EO 040
Biñan 041
Binangonan 042
Binondo 043
Bislig 044
Boac 045
 CLASS D
BOC EO 046
BOC POM Tellering Booth 047
BOC MICP 048
Bogo 049
Bongao 050
Bonifacio Global City 051
Bontoc 052
Borongan 053
Brooke's Point 054
BSP Servicing Unit 055
Buendia 056
Buguias 057
Buluan 058
Butuan 059
Buug 060
Cabadbaran 061
Cabanatuan Maharlika Highway 062
Cabanatuan Nueva Ecija 063
Cabarroguis 064
Cabuyao 065
Cadiz 066
Cagayan de Oro City PPA EO 067
Cainta 068
Calamba 069
Calamba EO 070
Calapan 071
Calasio 072
Calbayog 073
Caloocan EO 074
Caloocan 075
Calumpang EO 076
Camiguin 077
Camiling 078
Camp Aguinaldo 079
Camp Crame 080
Candelaria 081
Candon 082
Capas 083
Capistrano 084
Carcar 085
Carigara 086
Carmen 087
Carmen Cagayan de Oro 088
Cash Department 089
Catarman 090
Caticlan EO 091
Catbalogan 092
Cauayan (I) 093
Cavite City 094
Cebu-Capitol 095
Cebu-Osmeña Blvd. 096
Cebu-Toledo 097
Clark 098
COA 099
Commonwealth 100
Consolacion EO 101
Concepcion (Tarlac) 102
Coron 103
Cotabato 104
 CLASS D
Cotabato City Hall EO 105
Cubao 106
Culasi 107
Daet 108
Dagupan 109
Dagupan Caranglaan 110
Dalaguete EO 111
Danao 112
Dapitan 113
Daraga 114
Dasmariñas 115
Dau 116
Davao (Recto) 117
DECS EO 118
Digos 119
Dinagat 120
Dinalupihan 121
Dipolog 122
DOLE EO 123
Don Carlos 124
DOTC 125
Dumaguete 126
East Avenue 127
EDSA Congressional 128
EDSA Greenhills 129
EDSA-NIA Road 130
Elliptical Road 131
España 132
Fort Bonifacio 133
FTI 134
G. Araneta 135
Gaisano (Iloilo) 136
Gapan 137
Gen. Santos (Gaisano) EO 138
Gen. Santos (Highway) 139
Gen.Santos (Pioneer) 140
Gingoog 141
GMA (Cavite) 142
Goa 143
GSIS 144
Guadalupe 145
Guagua 146
Guihulngan 147
Guimaras (Jordan) 148
Guimba 149
Guiuan 150
Gumaca 151
Hernaez EO 152
Iba 153
Ilagan 154
Iligan 155
Iloilo 156
Imus 157
Infanta 158
Intramuros-BIR Tellering Booth 159
Intramuros 160
Ipil 161
Iriga 162
Irosin 163
 CLASS D
Island City Mall EO 164
Isulan 165
J.P. Rizal 166
Janiuay 167
Jaro 168
Jolo 169
Kabacan 170
Kabankalan 171
Kalibo 172
Katipunan 173
Kidapawan 174
Kidapawan EO 175
Koronadal 176
La Trinidad 177
Labo 178
Lagawe 179
Laoag 180
Lapu-lapu 181
Lapu-Lapu EO 182
Las Piñas 183
Lebak 184
Legazpi 185
Lemery 186
Ligao 187
Liloy 188
Lingayen 189
Lipa 190
LTO EO 191
Lucban 192
Lucena 193
Luna 194
LWUA EO 195
Maasin 196
Makati Atrium 197
Makati Business Center 198
Makati City Hall 199
Malabon 200
Malacañang 201
Malacañang EO 202
Malaybalay Highway 203
Malita 204
Malolos Highway 205
Malolos Plaza 206
Mamburao 207
Mandalagan EO 208
Mangaldan EO 209
Mandaluyong City Hall EO 210
Mandaue 211
Mandaue EO 212
Maramag 213
Marawi 214
Marcos Highway 215
Marikina 216
Mariveles 217
Masbate 218
Mati 219
Matina 220
Meycauayan 221
Midsayap 222
 CLASS D
Molave 223
Mulanay 224
Muñoz 225
Muntinlupa 226
Nabunturan 227
Naga 228
Naga Rotunda 229
Nagcarlan EO 230
NAIA Arrival EO 231
NAIA Terminal III EO 232
NAIA-BOC 233
NaPoCor EO 234
Narvacan 235
Nasugbu 236
Naval 237
Navotas 238
North Avenue 239
Novaliches 240
Odiongan 241
Olongapo 242
Ombudsman EO 243
Ormoc 244
Oroquieta 245
Ortigas Center EO 246
OWWA EO 247
Ozamiz 248
Pagadian 249
Panabo 250
Paniqui 251
Parang 252
Pasay 253
Paseo de Roxas 254
Paseo de Sta. Rosa EO 255
Pasig C. Raymundo 256
Pasig Capitol 257
Pasig City Hall EO 258
Pasong Tamo 259
Passi 260
Pateros 261
PCSO EO 262
Peza Taguig EO 263
Pili 264
Pinamalayan (Mindoro) 265
Plaza Independencia 266
Plaza Libertad 267
Polangui 268
Polomolok 269
Polomolok DOLE Phils. EO 270
Puerto (CDO) 271
Puerto Princesa 272
Puerto Princesa EO 273
Pulilan 274
Quezon Avenue 275
Quezon City Circle 276
Quezon City Hall 277
Rosario (Batangas) 278
Rosario Cavite (CEZ) 279
Rosary Heights 280
Roxas (Capiz) 281
 CLASS D
Roxas (Isabela) 282
Roxas (Mindoro) EO 283
Roxas Blvd. (Libertad) 284
Sablayan EO 285
Sagay 286
San Carlos (NO) 287
San Carlos (Pangasinan) 288
San Fernando (LU) 289
San Fernando (Pampanga) 290
San Francisco 291
San Isidro (Isabela) 292
San Isidro (NE) 293
San Jose (Mindoro) 294
San Jose City (NE) 295
San Jose del Monte 296
San Juan (Batangas) EO (#357) 297
San Juan 298
San Mateo (Isabela) EO 299
San Nicolas EO 300
San Pablo (Laguna) 301
San Pedro (Davao) 302
San Pedro (Laguna) 303
Sanchez Mira 304
Santiago 305
Sara 306
Senate EO 307
Shaw Boulevard 308
Sindangan 309
Siniloan 310
Sipalay 311
Sipocot 312
Siquijor (Larena) 313
Sogod 314
Solano 315
Sorsogon 316
South Harbor 317
South San Fernando (LU) 318
Sta. Cruz (Laguna) 319
Sta. Cruz Capitol 320
Sta. Maria 321
Sta. Rosa 322
Sto. Tomas (Batangas) EO 323
Subic 324
Sucat 325
Supreme Court EO 326
Surallah 327
Surigao 328
Tabaco 329
Tabuk 330
Tacloban 331
Tacloban Real 332
Tacurong 333
Taft Avenue 334
Tagaytay 335
Tagbilaran 336
Tagudin EO 337
Taguig City Hall 338
Tagum 339
Tagum EO 340
 CLASS D
Talavera 341
Talibon 342
Tanauan 343
Tanay 344
Tandag 345
Tarlac 346
Taytay 347
Tayug 348
Tayuman 349
Tigaon EO 350
Toril EO 351
Trece Martires 352
Tubod 353
Tuguegarao (Capitol) 354
Tuguegarao 355
U.N. Avenue 356
UP Diliman EO 357
UP Los Baños 358
UP Miag-ao 359
Urdaneta 360
Valencia 361
Valenzuela 362
Velez 363
Victorias 364
Vigan 365
Villamor Airbase EO 366
Virac 367
Wao 368
West Avenue 369
West San Fernando (Pampanga) 370
WMSU EO 371
YMCA 372
Zamboanga Main 373
Zamboanga Veterans 374
 CLASS D

01 01 GOCC
02 02 NGA
03 03 LGU
04 04 Private Corporation
05 05 Partnership
06 06 Cooperative
07 07 SME
08 08 Educational and Health Institution
09 09 Development Partner
10 10 Religious and Charitable Organization
11 11 Commercial/Universal Bank
12 12 Thrift Bank
13 Rural Bank
14 Other Financial Intermediary
15 NGO/People Organization/Association
16 Micro-Enterprise
17 Sole Proprietorship
18
19
20
21
22
23
24
25
26
27
28
29
30
31
 LAND BANK OF THE PHILIPPINES
CLASS D
Roxas (Capiz) Branch

/ New Enrollment Update Enrollment Delete Enrollment

Name of Institution Short Name
AGBALO ELEMENTARY SCHOOL AES
USER PROFILE
Name
MARY ANN MORALES ROXAS

First Name Middle Name Last Name

Address ZIP Code Country

MALIPAYON VILLAGE, TIZA ROXAS CITY CAPIZ 5800 PHILIPPINES
No. Street Barangay/District Municipality/City Province

User ID Position/Designation Gender Date of Birth E-mail Address

ANN1969 PRINCIPAL II Female 03 - 07 - 1969 maryann.roxas001@deped.gov.ph

M M D D Y Y Y Y
vToken ID Contact Number/s Civil Status Tax Identification Number (TIN)
Landline Mobile 09985470887 912 921 189 000
N/A Single Divorced - - -

Challenge Questions / Married Separated FOR BANK USE ONLY

1. Mother's Complete Maiden Name PERLA VILLASIS DESTAJO Widowed Internet Password Mailer ID
2. Name of High School PSPC PONTEVEDRA - - -
3. Grandfather's Name CLIMACO DESTAJO

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
/ Account Information Fund Transfer Current Account Services
Add Maker 0472 - 1261 - 05 ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

MARY ANN M. ROXAS MARY ANN M. ROXAS

Signature over Printed Name of User Signature over Printed Name of Authorized Signatory Date

FOR BANK USE

SERVICING BRANCH/EO SYSTEMS IMPLEMENTATION DEPARTMENT

Reviewed by Verified by Approved by Checked by Enrolled by Date

Distribution Copy 1 - SID Copy 2 - Institutional Client Copy 3 - Depository Branch

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) User ID must be composed of 6-8 alphanumeric characters, letters using upper cases only. The number zero should be written as "Ø"
to differentiate from the letter "O".
(3) Vtoken ID must be composed of 8 alphanumeric characters. The number zero should be written as "Ø" to differentiate from the letter "O".
1/
Authority of the designated user.
2/
Fund Management includes Auto Crediting, Auto Debiting and Fund Sweeping Modules. page 2