OPLDT •smart iSun O New Customer O Customer Records Update (for existing SMART customers)

BUSINESS CUSTOMER INFORMATIONFORM

To be filled out by the Customer
Date Accomplished/Signed:

BASIC CUSTOMER INFORMATION

Registered Business Name: Main Tele hone No. runkline:
Fax No.:
Store/Shop/Outlet Name/Trade Name: Customer's E-mail Address:
Website:
Business Address:

Billing Address (if different from Business Address):

Names of Bill Recipients 1. 2.

Contact numbers of Bill Recipients 1. 2.
Email Address of Bill Recipients 1. 2.
Finance Officer : Finance Offcer Contact Number: Finance Offcer's Email Address:
Business Ownership: O Private Government
Tax Class: VAT Exempt/ Zero-Rated With VAT O Others, please specify
SEC Registration No.
Company TIN:
Industry Type : Please specify

AUTHORIZED SIGNATORY INFORMATION

Name of Authorized Signatory: Position and E-mail Address: Contact NO.[Landline NO, & Mobile NO.)

ID Presented:
CompanyID; ID No. O Passport:ID No. Cl Others ID No.
O Drivers License; ID No. O SSS/GSIS ID: ID No.

ORGANIZATION DATA
Type of Business (Checkonly one) C] SINGLE PROPRIETORSHIP C] PARTNERSHIP a CORPORATION
Date of Registration: No. of Years in Operation:
FOR CORPORATION
Contact No. Email Address

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:
ILL DELIVERY AGREEMENT
YOUR ACCOUNT WILL BE AUTOMATICALLY ENROLLED IN PAPERLESS BILLING AT THE EMAIL ADDRESS YOU PROVIDED.
l/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 l/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 provided PLDT/Smart. i/We agree to hold PLDT/Smart free and harmless from any liability for my/our failure to receive the Bili despite it
being Sent to my/our email address. By Agreeing to receive our Bill via email, l/we understand that l/We will no longer receive a printed copy Of my/our bill. Should l/we opt to receive a printed copy Of my/Our bill, l/we
will course my request through any of the following channels: For PLOT • PLOT Hotline by dialing 177, PLOT Enterprise Facebook, pldtent_cares Twitter account orenterprisecare@pldt.com.ph email. For Smart —Smart
Corporate Hotline by dialing #888 or email Enterprisesupport@smart.com.ph (Postpaid) , EnterpriseBro@smart.Com.ph (Broadband).

SOLE PROPRIETOR DISCLOSURE

My signature below signifies that

1. I hereby authorize PLOT INC. and/or any person authorized by PLOT to obtain relevant and pertinent personal information about myself and credit information from the PLOT 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 PLDTs disclosure Of information concerning myself or my subscription to these companies. acknowledge that a complete list Of the entities under the PLOT Group can be accessed by myself on the PLOT website (
http;//www.pldt.com/privacrpolicy]

2. I also hereby authorize PLDTto use and disclose to the PLOT 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/behaviorwith respect to my subscription, and an
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 PLOT Group and its
subsidiaries and its authorized business partners; (c)advertising new products and services being offered by PLOT 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 octf_ver9 with OPA and "11 _oaonon