Professional Documents
Culture Documents
BORROWER DETAILS
Borrower's Name (First Name, Middle Name and Last Name) TIN SSS/GSIS/UMID # (please encircle ID used)
Mother's Maiden Name (First Name, Middle Name and Last Name) Nationality Filipino
Non-Filipino, please specify:
Birthdate (mm/dd/yyyy) Place of Birth Gender No. of House/s Owned No. of Car/s Owned
Educational Attainment Undergraduate Post-Graduate Civil Status Single Common Law Relationship Legally Separated Divorced
College Married Separated Annulled Widowed
Mobile Number Telephone Number E-mail Address
Home Address Unit #, Building/House #, Street, Subdivision/Barangay/District Municipality/City Province Zip Code
Permanent Address Unit #, Building/House #, Street, Subdivision/Barangay/District Municipality/City Province Zip Code
Residence Ownership Owned Mortgaged; Monthly Amortization Expense Length of Stay in Current City
Living with relatives Rented; Monthly Rental Expense
Source of Funds Business Savings/lnvestments Others Monthly Income
Salary Pension/Remittance
Employer Telephone Number Position
Employer's Address (Unit #, Building/House #, Street, Subdivision/Barangay/District, Municipality/City, Province, Zip Code) Tenure in the Company
BUSINESS DETAILS
Doing Business As (Trade Name) Telephone Number(s) E-mail Address
Business/Billing Address Unit #, Building/House #, Street, Subdivision/Barangay /District Municipality/City Province Zip Code Length of Stay in Current City
Office/Factory/Facility Location (Please list down and indicate ownership; submit a separate sheet for the complete listing if necessary)
Firm Size Micro (Assets <=P3M) Small (Assets >P3M to 15M) Medium (Assets >P15M to 100M) Large (Assets >P1OOM)
Location of Branches/Offices
SPOUSE DETAILS
Spouse Name (First Name, Middle Name, and Last Name) Gender Birthdate (mm/dd/yyyy) Place of Birth
Mother's Maiden Name (First Name, Middle Name and Last Name) TIN Mobile Number E-mail Address
Employer's Address (Unit #, Building/House #, Street, Subdivision/Barangay/District, Municipality/City, Province, Zip Code)
UNIBANK RELATIONSHIP
Do you have a deposit account with the following: BPI
BPI Family Savings Bank (BFSB)
None
Do you have a loan account with the following: BPI BPI BanKO
BFSB None
BPI Century Tokyo Lease & Finance Corp. (BPI CTL) Type of Loan/s Availed: _________________
Loan Type Credit Line Php Term Loan Php Tenor months
1.
% share to Total Sales of the Company Credit Terms/Mode of Payment
2.
% share to Total Sales of the Company Credit Terms/Mode of Payment
3.
% share to Total Sales of the Company Credit Terms/Mode of Payment
Supplier References (YOU MAY PROVIDE SEPARATE SHEET IF YOU HAVE MORE THAN 3 SUPPLIERS)
Name of Top Suppliers Contact Person Contact Number Credit Terms/Mode of Payment
Local
1.
Country of Origin Email Address
Foreign
Surety’s Name (First Name, Middle Name and Last Name) Relationship (to borrower) Date of Birth (mm/dd/yy)
Surety’s Name (First Name, Middle Name and Last Name) Relationship (to borrower) Date of Birth (mm/dd/yy)
PLEASE FILL OUT STATEMENT OF ASSETS, LIABILITIES, AND NET WORTH OF BORROWER AND SURETY/IES BELOW (IN PHP)
(Please attach a separate sheet as necessary)
Please see attachment for details
Borrower Spouse (if applicable) Surety (if applicable)
Other Assets
Net Worth
Name of Banks 1. 2. 3.
Type of Facility
Credit Limit
Currency
Collateral Offered
Interest Rate
RELATIONSHIP TO BPI, BFSB, AND BPI SUBSIDIARIES AND AFFILIATES, ETC . (in line with BSP Cir. 749)
Are you a Director, Officer, or Stockholder (DOS) of Yes If Yes, specify your company and position Company (e.g., BPI) Affiliation/Position (e.g., Director)
BPI, BFSB, BPI CTL, BPI CTR, BPI Capital Corporation, No or affiliation
BPI Direct Banko Savings Bank, BPI Asset
Management and Trust Corporation, BPI/MS
Insurance Corporation, or BPI Securities Corporation
(collectively, the "BPI Group of Companies" and
each, a "member of the BPI Group of Companies")?
Are you related to a DOS of any member of the Yes If Yes, specify: (i) the name/s and Name - Relationship to DOS - Company & Position
BPI Group of Companies or the Ayala Group of No relationship, such as, but not limited to: (e.g., Juan Dela Cruz - First Cousin - BPI, AVP)
Companies (e.g., Ayala Corporation, Ayala Land Inc., spouse, relative by consanguinity or
etc.)? affinity (e.g., parent, child, brother,
sister-in-law, grandparent, niece, uncle,
Note, Please disclose all relationships. A separate sheet may be first cousin, etc.) or others (e.g., general
attached if necessary. partner, co-owner of collateral, etc.); (ii)
the company in which said person is a
DOS; and (iii) his position therein.
We certify that the information we provided herein are true, accurate and complete, and we agree to notify/update BPI of any change in any of the information supplied in this form. BPI
shall not be responsible for our failure to update this form. We further warrant that, prior to submitting to BPI any information (including personal information) of an individual, we have
obtained all necessary authorizations and consents as may be required by applicable confidentiality and data privacy laws or agreement to enable BPI to process such information. Pursuant
to the requirements of Republic Act (R.A.) No. 9510, we likewise authorize and consent to BPI’s submission and disclosure of our basic credit data including updates and corrections thereto
to the Credit Information Corporation (CIC), the Bankers Association of the Philippines (BAP) credit bureau and such other credit bureaus and credit information companies for purposes of
credit evaluation and assessment.
We further acknowledge to have read, understood and agreed to be bound by the terms and conditions of the deposits, products, services, facilities and channels, as the same may be
amended or supplemented from time to time, which we opened/availed or which were provided and/or are made available to us via www.bpi.com.ph or through such other available
channels or electronic applications selected by BPI. Our application, enrollment, availment, access, maintenance, and continued use of any of the products, services, facilities and channels
shall constitute our acceptance and agreement to the applicable specific terms and conditions.
We likewise agree that BPI, each member of the BPI Group of Companies, their marketing partners and third parties, whether within or outside the Philippines (the "Program Partners")
and their respective authorized representatives, agents and service providers, under an obligation of confidentiality, may pursue marketing initiatives and communicate such customer
offerings and promotional opportunities to us through email, SMS, mail, telephone calls, social media, e-commerce and telemarketing platforms or any other means of communication or
channels which BPI or such member of the BPI Group of Companies may deem appropriate for the purpose.
By signing this form or by availing or continuing to avail of the products, services, facilities and channels of BPI or of any member of the BPI Group of Companies or Program Partners, we
agree that all personal information of individuals related to us, our transactions, business and credit relationships, accounts or account information or records which are with the Bank,
made available or submitted to the Bank, whether through electronic means or such other modes deemed appropriate by the Bank, or are in the Bank’s possession or updated from time
to time, may be collected, obtained, used, stored, consolidated, processed, profiled, benchmarked, shared to and disclosed, by and between or among BPI and any member of the BPI
Group of Companies, their successors and assigns, and their respective authorized representatives, agents and service providers, for any or all the purposes described in the Data Privacy
Statement published at www.bpi.com.ph and deemed incorporated by reference in this form.
The foregoing constitutes our express consent under the applicable bank secrecy, confidentiality and data privacy laws of the Philippines and other jurisdictions and we agree to hold BPI,
each member of the BPI Group of Companies, the Program Partners and their respective directors, officers, employees, authorized representatives, agents and service providers, free and
harmless from any and all Iiabilities, claims, damages, suits, costs, and expenses resulting from or in connection with the implementation of the purposes and authorities conferred by us
hereunder.
Minimum Documents . Duly accomplished application form . DTI registration . Business permit
. AFS for the last 3 years . BSP registration (depending on nature of business) . Bank statements (last 3 months)
. ITR for the last 3 years . Photocopy of government ID . SPA (for authorized representatives)
Additional documents may be required depending on the industry and loan purpose (to be discussed by the BPI Sales Representative)
FOR BANK USE ONLY
ECRM Opportunity # Application ID Credit Processing Type SBC
CC
Application Source Preferred RM Branch Referred Business Banking BSO Others: _________________
Corporate RM Business Banking RM Business Banking BLA
Rela Code Referror Name & Employee No. (BPI Employee) or Agent Name (Non-BPI Employee)
Referror PCC Code (BPI Employee) Referror Branch Name & Branch Code (BPI Employee)
Comments
To know more about how BPI Business Banking can be of service to you,
feel free to set an appointment or email us at bbclientservices@bpi.com.ph.
17/F Ayala North Exchange - Tower 1, 6796 Ayala Avenue corner Salcedo Street, Legaspi Village, Makati City 1229
(02) 7-918-2000 for Metro Manila; (+63) 917-509-6001 to 6002 (Globe) or
(+63) 998-987-2001 to 2002 (Smart) for outside Metro Manila
BPI Business Banking Customer Care: bbcustomercare@bpi.com.ph
To enable me/us to fulfill my/our financial transactions through accounts maintained with Bank of the Philippine Islands (the
“BANK”), I/we ____________________________________________________________________________________________
(the “CLIENT”) hereby authorize the BANK to accept, rely upon and act on email instructions to which forms, letters of authority,
instruments, certifications and/or such other electronically signed documents bearing an electronic signature are executed and
transmitted to the BANK in portable document format (“PDF”) form via the DocuSign platform, with intent to legally bind CLIENT
as fully as if said CLIENT had physically signed a paper copy of said instructions and/or forms, letters of authority, instruments,
certifications or documents, transmitted to the BANK in accordance with the guidelines outlined in Annex "A" using the CLIENT’s
email addresses registered with the BANK and set out in Annex "B", all forming part hereof (the “Instructions”), it being
understood and agreed that the BANK is authorized to treat the CLIENT’s Instructions transmitted electronically bearing electronic
signatures affixed and sent via the Docusign platform as original signatures conclusive, valid and enforceable on the CLIENT and
having the same legally binding force and effect as its wet or handwritten signatures.
These Instructions are limited to the following Transaction Documents:
Upon request of the BANK, CLIENT agrees to submit original transaction and/or supporting documents in cases where the BSP or
other relevant regulatory agencies require its submission for post-verification purposes.
REPRESENTATIONS AND WARRANTIES
CLIENT represents and warrants to the BANK on a continuing basis that:
(a) any Instructions given hereunder do not violate applicable laws, rules and regulations;
(b) the Instructions provided hereunder by the CLIENT are complete, true and correct and that the BANK is entitled to rely on
such Instruction, without liability;
(c) the authorized signatories signing this Authorization electronically and transmitting the Instructions via the DocuSign platform
have the appropriate authority to do so in accordance with its duly approved Secretary’s Certificate/Board Resolutions submitted
to the BANK;
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(d) the CLIENT is ultimately responsible for the Instructions and ultimately benefits from and bears the risk of any and all
transactions performed by the BANK ;
(e) the CLIENT understands the nature and suitability of the types of transactions or accounts contemplated herein and the risks
involved in them and that it has sufficient experience and sophistication to assess the suitability of such transactions; and
(f) all representations and warranties under the loan documents and/or relevant agreements are true and correct and will be
true and correct on each transaction made pursuant to this Authorization.
IMPLEMENTATION OF INSTRUCTIONS
The BANK is authorized to rely and act, without liability, upon the Instructions received by it in accordance with this Authorization.
The BANK reserves the right to require the CLIENT’s Instructions to be contained or sent in a particular form or with supporting
documents.
All financial transactions implemented by the BANK in accordance with the procedures set out in Annexes “A” and “B” hereof
shall be conclusive and binding on the CLIENT. The PDF image of each Transaction Document received electronically by the BANK
through the DocuSign platform shall be accorded all the benefits of an original document bearing an original signature and is valid
and legally binding on the CLIENT. Failure of the CLIENT to comply with the submission requirements covering loan availments,
foreign exchange and/or trade transactions for whatever reason shall not constitute a revocation of nor affect the validity of said
Instructions.
CLIENT agrees that phone conversations between the CLIENT and the BANK may be recorded and any such recording or transcript
thereof shall be conclusive evidence of the contents and shall be admissible in evidence in any proceedings related to this
Authorization or the transactions covered thereby.
The BANK shall not be responsible or liable for any delay, non-performance or failure to perform any or all of the Instructions of
CLIENT for reasons due to, directly or indirectly, arising out of or caused, by circumstances beyond its control including, without
limitation, acts of God, natural disasters, epidemics, pandemics, system failure or system downtime, network or
telecommunication failure, regulatory, government actions or self-regulatory actions of the BANK which may include the
institution of its Business Continuity processes. The BANK shall likewise not be responsible for any special, indirect, incidental,
exemplary or consequential damages, including but not limited to, lost profits or lost opportunities.
ACKNOWLEDGMENT OF RISKS
The CLIENT acknowledges and is fully aware of the risks related to the implementation of the Instructions and has taken into
account the inherent consequences of giving Instructions through electronic mail transmission. CLIENT also understands the risks
of forgery, falsification, electronic hacking or those arising from fraud, in the absence of mitigants employed in its own work
environment.
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By signing in this signature page, CLIENT acknowledges and confirms that it has read, understood and accepted the terms and
conditions herein and all pages contained in this Authorization including the Annexes (and each amendment or supplement
thereto), all of which accurately reflect the CLIENT’s intent and agreement.
________________________________________ ____________________________________
Authorized Signatory Authorized Signatory
(Signature over Printed Name) (Signature over Printed Name)
I hereby attest that I have witnessed the signing by the CLIENT of this Authorization including the Annexes, Secretary’s Certificate
/ signature card. I further confirm that I have validated the information provided herein and that the signature affixed is their
true and original signature and have been verified through submitted valid IDs and/or signature card on file.
Date : ___________________________________
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ANNEX "A"
Procedural Guidelines for Creation, Execution, Transmission and Receipt of DocuSign-Executed Documents
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ANNEX "B"
NAME OF CLIENT :
DATE :
Authorized Makers
The following are duly authorized to electronically transmit Instructions to the BANK via the DocuSign platform using their
respective Registered Company Email Addresses listed below:
The following are duly authorized to approve and sign Instructions, documents, forms, letters of authority, instruments and
certifications electronically via the DocuSign platform which will have the same force and effect as their original, wet or
handwritten signatures, valid and legally binding on CLIENT and transmitted to the BANK using their respective Registered
Company Email Addresses listed below: