INFORMATION SHEET

Sales Agent

*Only completely filled-out information sheets will be processed. Indicate if information is Not Applicable (Attach photo here)
*Do not type. Please write information legibly.
* Avoid erasures, changes in the form should be countersigned
*Attach your latest photocopy of 2 government IDs with photo and signature

Date: ________________________________________________
Affiliated Agency: _____________________________________

Personal Information

Name (Last/Given/Middle) : _____________________________________________________________________ Gender (M/F): ______________________

Date of Birth (mm/dd/yyyy): _____________________________________________________________________ Place of Birth ______________________
Residence Phone: ______________________ Office Phone : _______________________ Mobile Phone: ____________________ Fax No. ______________
Present Address: ______________________________________________________________________________________________ Zip Code: ______
Present Home Ownership: ________________ Owned _________________Rented _______________ Living with Parents _______________ Boarder
Previous Address: _______________________________________________________________________________________________________________
Civil Status: ______________ Single ________________ Married ________________ Separated _______________ Widowed ______________ Others
Height : ____________________ Weight: ___________________ Complexion (Fair / Dark / Medium) : __________________________________________
Distinguishing Marks On Face (Mole / Birthmarks / etc) __________________________________________________________________________________
Languages/Dialects Spoken : ______________________________________________________________________________________________________
Car Ownership : _____________ None _____________ Yes. How many? ___________________
Special Skills: _________________________________________________________________________________________________________________

Name of Spouse: ______________________________________________________________Birth Date of Spouse: ________________________________

Occupation / Position of Spouse: ___________________________________________________________________________________________________
Company Address of Spouse : ____________________________________________________________________________________ Zip Code: ______
Office Tel. No. : _______________________________ Mobile No. : ____________________________ Fax No. ____________________________________

Educational Background

Name of School / Address Course Years Covered

Elementary
High School
College
Post-Graduate
Vocational Course

Employment Background

Mo. / Yr Mo. / Yr
Company Name / Address Tel Number /s Position Supervisor's Name
Started Ended

Type of Product/s Handled

Profile of Clients
Data Base / Quantity

Personal References:

Name Relationship Occupation Company Name and Address Phone Number

Passport No. : ________________________________________ Issued at: _________________________ Issued On: ______________________________

SSS Number : ______________________________________________Tax Identification Number (TIN): __________________________________________

Please answer truthfully

1. Have you applied or have you ever been sourced coded by any Equicom Savings Bank (EQB) for any position before? ( ) Yes ( ) No.
If YES, when & indicate the Agency Name:
2. Have you ever worked for EQB or its units, affiliates and subsidiaries before for any position? ( ) Yes ( ) No
3. Have you been charged or convicted to any civil or criminal case before? ( ) Yes ( ) No
4. Are you related to anyone who was, in the past or is presently, a sales agent selling EQB products? ( ) Yes ( ) No
If YES, Please state the name :

LOANS

Bank Type of Loan Amount Balance Date Granted Expiry Remarks

DEPOSIT ACCOUNTS / PLACEMENTS

Bank & Branch Account No. Date opened ADB Balance Experience
 CREDIT CARDS

Issuing Card Company Card Number Date Approved Date of Expiry Limit Outstanding Balance Experience

I hereby certify that all information that I have written in this application form are true and correct to the best of my knowledge. I understand that any misrepresentation
on my part may be a ground for the disapproval of my application as Direct Sales Agent of ________________________________________ . Further, I hereby
authorize the Bank to verify and obtain information regarding my employment, bank accounts, credit accommodations and balances, credit card facilities, loan/s and
other information regarding my employment that may be required in order to facilitate my pending application as Direct Sales Agent with EQB.

The undersigned understands and acknowledges that the Bank may approve or decline my application as Direct Sales Agent after conducting the evaluation and review.
Noted By:

____________________________________________________ _______________________________________________________________
Agent's Signature over Printed Name dd / mm / yyy Agency Manager's Signature over Printed Name dd / mm / yyyy

What is Republic Act No. 8484?

An act regulating the issuance and use of access devices, prohibiting fraudulent acts committed relative thereto, providing penalties and for other purposes.

Section 1. Short Title. - This act shall be known as the “Access Devices Regulation Act of 1998.”
™
Section 9. Prohibited Acts. - The following acts shall constitute access device fraud and are hereby declared to be unlawful:

(a) trafficking in one or more unauthorized access devices or access devices fraudulently applied for;
(b) using, with intent to defraud, an unauthorized access device;
(c) using an access device fraudulently applied for;
(d) possessing one or more counterfeit access devices or access devices fraudulently applied for;
(e) without the authorization of the issuer of the access device, soliciting a person for the purpose of
1. offering an access device; or
2. selling information regarding or an application to obtain an access device

Section 10. Penalties. - Any person committing any of the acts constituting access device fraud enumerated under Section 9, shall be punished with:
(a) a fine of P10,000 or twice the value obtained by the offense, whichever is greater and imprisonment for not less than 6 years and for not more than 10 years,

in the case of an offense under Section 9 (b) - (e), and (g) - (p) which does not occur after a conviction for another offense under Section 9;
(b) a fine of P10,000 or twice the value obtained by the offense, or imprisonment for not less than 12 years and not more than 20 years, or both, in the
case of any offense under Section 9, which occurs after a conviction for another offense under said subsection, or an attempt to commit the same.

Section 11. Conspiracy to Commit Access Device Fraud. - If 2 or more persons conspire to commit any of the offenses listed in Section 9 and one or
more of such persons does any act to effect the object of the conspiracy, each of the parties to such conspiracy shall be punished as in the case of the
doing of the act, the accomplishment of which is the object of such conspiracy.

Section 12. Frustrated and Attempted Access Device Fraud. - Any person who performs all the acts of execution which would produce any of the
unlawful acts enumerated in Section 9 of this Act, but which nevertheless does not produce it by reason of causes independent of the will of the said
person, shall be punished with 2/3 of the fine and imprisonment provided for the consummated offenses listed in said section. Any person who commences
the commission of any of the unlawful acts enumerated in Section 9 of this Act directly by overt acts and does not perform all the acts of execution which
would produce the said acts by reason of some cause or accident other than said person’s own spontaneous desistance, shall be punished with ½ of the
fine and imprisonment provided for the consummated offenses listed in the said section.

<insert Agency Name>

An accredited Sales Agency

Code of Practice, Ethics and Conduct for Direct Sales Agents:

I agree to abide the following:

1) At all times, I have to act promptly, diligently, and in a manner which is legal, ethical and reasonable, and in accordance with accepted business practice;
2) I shall not communicate with the loan or card applicant in a threatening or abusive manner;
3) At all times, I shall not act as a representative of the loan or card applicant and fill-up or sign the application , even if explicitly requested or authorized by the said
applicant;
4) I am strictly forbidden to collect any annual fee, service charges, other fees, commission or any form of reward or compensation from the loan or card applicant;
5) I shall strictly observe the rules, regulations and policies and follow instructions from the bank and my Direct Sales Agency;
6) I shall never retain, copy or duplicate applicant’s documents containing his personal data or information, for personal reference or use;

7) I am bound by the secrecy declaration and confidentiality clause and undertake to never disclose any confidential data of the applicant's or bank, to any third party;
8) In the event of detection or knowledge of any dishonest practices or any kind of misrepresentation within the workplace, I am obliged to inform the Direct Sales
Agency and Bank at the earliest instance;
9) I shall not give any false report to the bank;
10) I shall never talk to the media, on any bank matters, be it implied or otherwise;
11) I am not authorized to promise applicants, loan or card approval prior to processing, loan/credit limit, annual fee discount or waiver, additional gifts or premiums,
other than that advertised in the promotion, and other benefits pertaining to the loan / card product;
12) I shall ensure that all new applications solicited are promptly and accurately recorded, and advised to the Direct Sales Agency Managers;
13) I shall ensure that all complaints received are made known to the Bank and handled promptly and satisfactorily;
14) I shall be presentable at all times, with regards to dress, personal hygiene, language, etc., in keeping with the professional public image of the Bank;
15) I shall only sell products as specified and cleared by the Bank.
16) I am aware and shall comply with Republic Act 8484 (RA 8484) .
17) I warrant that I have ascertained the true identity of the applicants submitted to the Bank; all such applicantants are bonafide applicants and no applications are
submitted for the purpose of defrauding the Bank.

Breach of any of the above shall result in my immediate disaffiliation. Likewise, I hereby authorize the Bank to hold &/or deduct any commission &/or
incentive due to me which will be set-off arising from the infractions I committed as an Agent of the Bank.

Conforme:

____________________________________________________ _______________________________________________________________
Agent's Signature over Printed Name dd / mm / yyy Agency Manager's Signature over Printed Name dd / mm / yyyy

For EQB purpose only:

Assigned Source Code: __________________________________
DSA Coordinator: _______________________________________
Approved by and Date: ____________________________________