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Client Information Form

This document is a client information form for an insurance company. It requests information from clients such as name, address, bank details, and a signature for a declaration. It also contains sections for the requestor to provide details of the request type and account information for the client. There is a section marked "For Finance Use Only" to update client details in the company's systems upon form completion.

Uploaded by

Gian Carlo Aniceto
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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3K views1 page

Client Information Form

This document is a client information form for an insurance company. It requests information from clients such as name, address, bank details, and a signature for a declaration. It also contains sections for the requestor to provide details of the request type and account information for the client. There is a section marked "For Finance Use Only" to update client details in the company's systems upon form completion.

Uploaded by

Gian Carlo Aniceto
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

INSURANCE COMPANY OF NORTH AMERICA

A Chubb Company
24th Floor Zuellig Building, Makati Avenue Corner
Paseo de Roxas Makati City 1226, Philippines

CLIENT INFORMATION FORM

GENERAL INFORMATION INPUT BY REQUESTOR

Request Type New Update Termination


Requestor Name
Department

ACCOUNT INFORMATION INPUT BY CLIENT

Client Name
Address
City
Postal Code
Country
Telephone/ Mobile Number
Business Contact Name

BANK DETAILS: INPUT BY CLIENT


Bank Country
Bank Name
Bank Branch
Swift Code
Account Name
Bank Account Number
Payment Currency
Remittance Email address

CLIENT'S DECLARATION

Signature Over Printed Name


Date

FOR FINANCE USE ONLY

BIR 2303 /Registration (for New )


Updated in PeopleSoft
Business Permit Vendor Masterfile

SEC (for Corporate), DTI (for Individual) Vendor ID


Bank Details

Contract Agreement Reviewed By:

Other Vendor Information


Approved By:

Chubb_Ph_Finance_10.10.2018_G:\Finance\Finance Files\VENDOR MASTER FILE\Vendor Information Form

INSURANCE COMPANY OF NORTH AMERICA A Chubb Company 24th Floor Zuellig Building, Makati Avenue Corner Paseo de Roxas Makati Ci

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