CUSTOMER INFORMATION SHEET

The information that you provide in this form will be treated with utmost confidentiality.

BUSINESS INFORMATION

Business Name: Business Address:

Telephone No: DTI/SEC Reg. No. Products Sold:

Bus. TIN No: Year Established:

E-Mail Address Phone Number

Form of Business Organization
Sole Proprietorship Partnership Corporation Export Processing Zone Top 20,000 Corporation
EWT Withholding Agent Yes (Provide Document) No
OWNER/PARTNER INFORMATION

Name:
Last First Middle

Address:

Birth Date: Sex: Citizenship:

Tel./Mobile No: Birth Place:

Other Contact Person

E-COMMERCE ENROLLMENT FORM

This self-service platform enables our customers to be in charge of their account information, manage their transactions, and access Holcim’s services. By signing this Customer
Information Sheet, you allow Holcim Philippines, Inc. to enroll you as the primary user of this facility using the data provided in the Business Information section.
If you prefer another email address and mobile phone number, please indicate below.

E-Mail Address Mobile Phone Number

SHIP TO CODE ENROLLMENT FORM

Shipto reflects your delivery address. This is where you would like your orders to be received.
Check if same as the data provided in the Business information section I don’t have delivery address to enroll

Shipto Name

Province Street Name

City/Municipality Contact Person at projectsite

Barangay or Village Mobile Number

House or Building No

PAYMENT CONDITION
Payment of the product purchased shall be in accordance with the agreed payment terms of the corresponding Sales Agreement or Invoice. Any amount not paid when due shall earn
interest of 1% p.a. from the date it become due and until fully paid.
MARKETING AND PROMOTIONS
Unless you check the boxes below, by providing your personal contact details, you are agreeing to receive offers and information about our products and services.
No - I don't want to receive offers and information about your products and services.
DATA PRIVACY CONSENT
1. I agree and consent for Holcim Philippines, Inc. (“HPI”) to collect, use, and process my personal data or the personal data of my authorized representative(s) or any other person(s) whose personal data I
provided in the attached form and/or agreement in relation to my dealings with HPI (the “Form”).
2. I authorize HPI to disclose my personal data, or the personal data of my authorized representative(s) or any other person(s) whose personal data I have provided within HPI and to other third parties
including, but not limited to, HPI’s affiliates, parent company and other related companies, third party service providers, suppliers, financial institutions, credit investigation and background screening
companies, government agencies, and external auditors only for the Purposes indicated below or as may be required under applicable laws (whether local or foreign), rules, and other regulations.
3. I acknowledge that my personal data, or the personal data of my authorized representative(s) or any other person(s) whose personal data I have provided, have been or will likewise be collected, used,
disclosed and processed by HPI for purposes which include, but are not limited to, the following:
(a) preparation of documents and performance of acts necessary or desirable to accomplish my request in relation to the attached Form;
(b) pursuant to our business dealings and/or transactions as covered by our agreement;
(c) conduct of a credit investigation, credit history and worthiness, and background screening;
(d) complying with reportorial, filing, and other legal requirements under the law, or as required by any request or direction of any governmental authority, or responding to requests for information from public
agencies, offices, statutory boards or other similar authorities;
(e) storing, hosting, backing up (whether for disaster recovery or otherwise) of my personal data which may be transferred to HPI’s affiliates or related companies, and third party service providers or agents
whether within or outside the Philippines for this purpose;
(f) responding to legitimate complaints, queries and/or requests by clients in connection with any work performed by HPI, third party contractors, and regulatory government agencies in connection with the
exercise of their statutorily mandated functions;
(g) organizing seminars, events or other marketing/promotional activities and posting of personal data obtained due to the said activities;
(h) handle any and all investigation, legal or other claims arising out of my transaction or request with HPI; and/or
(i) any other purposes which may be related to my initial request, business transaction and/or any of the foregoing purposes enumerated (collectively, the “Purposes”).
4. I understand that my personal data, and the personal data of my authorized representative(s) or any other person(s) whose personal data I have provided, shall only be retained for as long as necessary for:
(a) the fulfillment of the declared and legitimate Purposes, or when the processing relevant to such Purposes has been terminated, (b) for the establishment, exercise or defense of my and HPI’s legal claims,
or (c) in compliance with the retention periods provided by applicable laws (whether foreign or local) and HPI policies; and (d) for any other legitimate business purpose connected to the Purposes.
5. As a data subject, I understand that my rights, to the extent recognized by Republic Act No. 10173, otherwise known as the Data Privacy Act of 2012, its Implementing Rules and Regulations, and relevant
issuances of the National Privacy Commission (“DPA Laws”) shall be respected by HPI. This includes my rights to information, object, access, rectification, erasure or blocking, lodging a complaint, damages
and data portability. For these purposes, I understand that HPI adopts the necessary physical, organizational, and technical security measures required under the relevant law, rules, and regulations.
6. I represent and warrant that all the personal data provided by me to HPI shall be true and correct. I will update or correct any personal data I have provided, as and when necessary.
7. By providing personal data relating to third parties to HPI, I acknowledge and warrant that I have secured the necessary consents of the third parties in accordance with the DPA Laws.
8. I understand that for any questions or complaints regarding HPI handling of my personal data or HPI compliance with the DPA Laws, I may contact its data protection officer through:
Email: dpo-phl@lafargeholcim.com
Mail:Data Protection Officer, Holcim Philippines, Inc., 7/F Two World Square,
Fort Bonifacio, 1634 Taguig City

I have read, understood, and agree to the above provisions.

Signature of Applicant / Authorized Signatory

Over Printed Name Date Signed

FOR HPHI USE ONLY

Sales Region: Sales Group and Name Employee Code

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