CLIENT INFORMATION SHEET

CONFIDENTIAL

NAME:

Surname Given Name Middle Name

ADDRESS: (Mailing Address)

No. Street. Subdivision/Village Barangay

Municipality Province Zip Code

Phone No/s: (Home Phone No.)__________________ (Office Phone No.)_________________

(Mobile Phone No.)____________________

Email Address: _________________ Would you like to receive Company Notifications via email? Y__ N__

Civil Status: __Single __Married __Separated __Widowed Gender: __Male __ Female

Date of Birth: MM__/DD__/YYYY_______ Citizenship: ______________________

Source of Funds: ___ Salary ___Business ___Donation ___ Inheritance ___Others: ________________

Type of Employment: Tax Identification Number: _____________________________

(Main Source of Income) ____ Employed

__Private __Government & Government-related __OFW

____ Professional
____ Business (Self Employed)
____ Others

INDUSTRY :
__Agriculture, Forestry & Fishing __Manufacturing
__Electricity, Gas, Steam & Air conditioning Supply __Transportation & Storage
__Water Supply, Sewerage, Waste Management & Remedial Activities __Education
__Wholesale & Retail Trade; Repair of motor vehicle and motorcycles __Real Estate Activities
__Accommodation & Food Service Activities __Construction
__Financial and Insurance Activities __Professional, Scientific and Technical Activities
__Information and Communication __Mining and Quarrying
__Administrative & Support Service Activities __Arts, Entertainment & Recreation
__Public Administration & Defense; Company Compulsory Social Security
__Human Health and Social Work Activities
__Activities of households as employers; undifferentiated goods and Services producing activities of household for
own use
__Activities of Extraterritorial Organizations & Bodies __Other Service Activities (specify)

ISIC CODE : ___________________________________________________________________________________

Name of Employer (if any) : _____________________________________________________________________
Group of Affiliation of Employer (if any) : __________________________________________________________
Signature : _________________________________ Date Signed : ____________________________
*To be filled up by Company Representative
Management Referred? __YES __NO If yes, Referrer’s Name : _____________________________
Verified by : ______________________ Date Received : ____________________________________

Note: Please submit accomplished Form together with a copy of any government issued ID.