CLASS B

LANDBANK OF THE PHILIPPINES

Branch

ENROLLMENT TYPE ETAX PAYMENT ENROLLMENT FORM

New Change Password Additional Authorized Enrollee Change Authorized Enrollee Change Registered Name
Enrollment
Updates(Please check the appropriate box for
Change Account Number Additional Account Number Change email address Change User ID
updates) Change TIN

REGISTERED NAME/TAXPAYER'S NAME TAXPAYER TYPE RDO TIN (Indicate the 12 digit number)
Individual NGA/SUC
Corporat
LGU
e
TAXPAYER'S ADDRESS CONTACT NO. E-TAXPAYER'S BRANCH CODE
(to be provided by BIR)

Any two
NAME OF AUTHORIZED ENROLLEE Any one (1) E-MAIL ADDRESS MOBILE NO.
(2) USER ID (SHOULD BE 4 CHARACTERS
ONLY (ALPHA/NUMERIC/COMBINATION)

1. 1. 1. 1.

2. 2. 2. 2.

3. 3. 3. 3.

4. 4. 4. 4.
ACCOUNT NUMBER/S TO BE ENROLLED (Please attached separate sheet for other account nos.)

1. 3. 5. 7.

2. 4. 6. 8.

DEPOSITOR'S SIGNATURE
I/we hereby agree to the terms and conditions governing the E-Tax Payment Facility of LANDBANK.

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name

For corporate taxpayers: a Board Resolution authorizing enrollment of the account(s), and designating authorized enrollees/password holders shall be required. It is the responsibility of the Board of Directors/Trustees of the
corporation to inform the bank of change in authorized enrollees.
FOR BRANCH USE FOR MCMD ENROLLMENT
This is to certify that all details and information written above are true, accurate and complete per validation with other
required documents submitted by the client. Copies of documentary requirements are safekept in the branch for reference.

Processed by Signature Verified by Approved by Enrolled by Checked by Approved by

Distribution : Original Copy: Branch Copy 2: MCMD Copy 3: Taxpayer
 CLASS B

TERMS AND CONDITIONS

A. Service Terms and Conditions
1. The service will be available to Me/Us upon approval by You of My/Our enrollment under the facility.
2. I/We understand that I/We shall be solely held responsible for the adequate security and precautionary
measures in order that all times the Facility shall only be furnished and disclosed to our authorized personnel.
As such, I/We shall not under any circumstances disclose My/Our user's password on the Facility.
3. I/We acknowledge that you shall be entitled to treat any notice, instructions or other communications which
from time to time be or purports to be given thru the internet, telephone, facsimile or other electronic means
by Us. You shall also be entitled to take such steps in connection with or upon reliance therefrom.
4. I/We hereby agree not to hold you any liable for any loss, damage or expenses which I/We may incur as a
result or in connection to the implementation of the e-Tax Payment Transactions in the following instances.
a. Disruption, failure or delay relating to or in connection with the Services which are due to circumstances
beyond your control, unforseen events, fortuitous events such as but not limitied to prolonged power outages,
breakdown in computers and communication facilities, typhoons, floods, public disturbances and calamities
and other similar or related cases.
b. Loss and damage suffered by us arising out of any fraudulent access or utilization of the e-Tax Payment
System due to theft or unauthorized disclosure of IDs, passwords or violation of other security measures used
for the e-Tax payment Facility with or without our participation.
c. Inaccurate, incomplete or delayed information received by the Taxpayer Enrollee due to the disruption or
failure of any communication facilities used for the System.
d. In case of insufficiency of fund at the time of receipt of payment
instructions.
5. You shall not be liable for any indirect, incidental or consequential loss, loss of profit or damage suffered by
the Taxpayer Enrollee by reason of its use or failure or inability to use the facility.
6. I/We agree that My/Our e-Tax Payment instruction received after 10:30 p.m. or Saturday, Sunday and
Holiday shall be considered as a transaction of the following banking day.
B. Charges
Enrollment and availment of the service is free of charge. You reserve the right to impose service fees, and other charges in
accordance with Your standing and future policies and to change or amend the same upon prior notice to Me/Us. Such charge
shall be deducted from My/Our account.
C. Service Availability
1. The Facility will immediately be available upon approval by you of My/Our enrollment
2. The availability of the Facility shall be subject to the Terms and Conditions from time to time contained in notices posted in
your branches, or information leaflets relating thereto available in your branches.
D. Change of Password
I/We may change My/Our password from time to time upon filling out the e-Tax enrollment Form.
E. Protecting My/Our Account
I/We understand My/Our role in the prevention of any wrongful use of My/Our account. I/We shall be responsible in promptly
examining My/Our confirmation advice sent thru E-Mail. If I/We find that My/Our records and yours disagree, I/We shall
immediately inform LBP Customer Care Center at 405-7000. The password that is used to access to the Facility shall at all times
be kept confidential by Me/Us. I/We shall be responsible for keeping My/Our password, account numbers and other account
data confidential. If I/We believe that My/Our e-Tax Payment password has been lost or stolen, or that someone has used it
without our permission, we shall notify LBP Customer Care Center at 405-7000.
F. Laws, Rules and Amendments
1. The facility shall be subject to Your (i) present and future policies (ii) the applicable rules and regulations relative to the
establishment and operation of the Facility.
2. You are entitled to revise or modify all or any of these Terms and Conditions.
G. Effectivity of Other Terms and Conditions
The Term and Conditions governing My/Our other accounts with you shall remain in full force and effect insofar as the same is
not inconsistent herewith.
H. Acceptance of Terms and Conditions
By utilizing Your facility described herein, I/We hereby acknowledge and confirm to have read, understood and agreed to be
bound by these Terms and Conditions and any future amendments thereto, and other materials as maybe provided by You.

7. I/We understand that the confirmation issued to Me/Us by the BIR is equivalent to the acknowledgment
receipt issued by You that is, it is an acknowledgement of My/Our e-Tax Payment instruction and not
necessarily a confirmation that My/Our e-Tax Payment has been successful or has already been accepted.

8. I/We agree that My/Our payment shall be deemed duly accepted upon our issuance to Me/Us of a
confirmation advice the day following your issuance of the above-mentioned acknowledgement receipt.
__________________________________ ________________________
9. I/We fully understand that should My/Our e-Tax payment be accepted/confirmed by You. You shall cause Enrollee's Signature Above Printed Name Date
the value dating of My/Our e-Tax Payment on the day of your acknowledgement of our e-Tax Payment
instruction. __________________________________ _______________________
10. I/We understand also that You in coordination with the Bureau of Internal Revenue (BIR) are entitled to
withdraw and/or vary and/or enhance any feature of the Service or to cancel My/Our enrollment on the facility Enrollee's Signature Above Printed Name Date
upon prior notice to Us.
__________________________________ _______________________
Enrollee's Signature Above Printed Name Date

__________________________________ _______________________
Enrollee's Signature Above Printed Name Date
 CLASS D

Date

Branch Manager's Name

Position
LBP Branch
Branch's Address

Dear Mr./Ms. ______________________________

In line with the implementation of Revenue Regulation No. 9-2001 and 10-2014 prescribing the electronic filing
of tax returns and payment of taxes, I/We would like to express our intention to avail of LANDBANK's Electronic
Tax Payment System (ETPS) to allow myself/us to pay for my/our taxes online anytime, anywhere.

Thank you.

Very Truly Yours,

Client's Full Name and Signature

 CLASS D
RESOLUTION NO. _______________

RESOLVED FURTHER, to authorize the corporation to enroll in the e-Tax Payment System of Land Bank of the Philippines,
and that the authorized users/enrollees of the said system shall be any o one (1) o two (2) of the following:

Name Position
1. _______________________________________________________________________________________________
2. _______________________________________________________________________________________________
3. _______________________________________________________________________________________________
4. _______________________________________________________________________________________________

RESOLVED FURTHERMORE, that Land Bank of the Philippines is authorized to debit the following account no./s upon our
instruction in order to effect our e-Tax Payment.

Account No./s
1. ___________________________________________________5. __________________________________________
2. ___________________________________________________6. __________________________________________
3. ___________________________________________________7. __________________________________________
4. ___________________________________________________8. __________________________________________

RESOLVED FINALLY, that this resolution shall be deemed valid and effective unless written notice of its revocation or
amendment is delivered to Land Bank of the Philippines.

IN WITNESS WHEREOF, I hereby sign this document this ________ day of _________________________ __20____ at
___________________________________________________________ .

CORPORATE SECRETARY

SUBSCRIBED AND SWORN to before me this _________ day of __________________________, 20 ______ at _________
_____________________________, affiant exhibiting to me his/her Community Tax Certificate No. __________________
issued on ______________________________________ at ______________________________________________.

NOTARY PUBLIC

Doc. No. __________

Page No. __________
Book No. __________
Series No. _________