Customer Information Form Institutional

I. CUSTOMER INFORMATION
Company/Corporate/Proprietor Name

Trade/Business Name

Tax Identification Number Date of Registration (mm/dd/yyyy) Country of Registration

Registered Business Address

Unit No. Floor Building Name Street Subdivision Barangay City/Municipality Province Country ZIP Code
Mailing Address

Unit No. Floor Building Name Street Subdivision Barangay City/Municipality Province Country ZIP Code
Primary Phone Number Email Address Mobile Number
(________) - __________-_________
Area Code Landline Number
Form of Business With Beneficial Owner?
☐ Sole Proprietorship ☐ Non-Stock Corporation ☐ Partnership ☐ Yes (request Beneficial Owner to fill-out a Customer Information Form – Annex
– Beneficial Owner Information.
☐ Stock Corporation ☐ Foundations ☐ Cooperative
☐ Publicly-listed ☐ Associations ☐ Registered Fund ☐ None
☐ Private ☐ Religious Organization
II.a ACTIVE AUTHORIZED SIGNATORY INFORMATION
Name (First Name, Middle Name, Last Name)

Date of Birth (mm/dd/yyyy) Place of Birth Nationality

City/Municipality Country
Address

House/Unit No. Floor Building Name Street Subdivision Barangay City/Municipality Province Country ZIP Code
Contact Number Email Address Industry (please choose code from the Industry List)

Source of Wealth
☐ Salary/Commission ☐ Business ☐ Pension/Allowance ☐ Donation/Inheritance ☐ Sale of Asset/Investment ☐ Winnings
II.b ACTIVE AUTHORIZED SIGNATORY INFORMATION
Name (First Name, Middle Name, Last Name)

Date of Birth (mm/dd/yyyy) Place of Birth Nationality

City/Municipality Country
Address

House/Unit No. Floor Building Name Street Subdivision Barangay City/Municipality Province Country ZIP Code
Contact Number Email Address Industry (please choose code from the Industry List)

Source of Wealth
☐ Salary/Commission ☐ Business ☐ Pension/Allowance ☐ Donation/Inheritance ☐ Sale of Asset/Investment ☐ Winnings
III. CLIENT PROFILE
Source of Wealth Industry (please choose code from the industry list) Size of Business
☐ Business ☐ Investment ☐Micro (up to ₱ 3,000,000) ☐ Medium (₱ 15,000,001 to ₱100,000,000)
☐ Donation ☐ Sale of Assets ☐ Small (₱ 3,000,001 to ₱ 15,000,000) ☐ Large (₱ 100,000,001 and above
Types of Products and Services to be Availed from the Bank
☐ Current/Checking and Savings Account ☐ Treasury ☐ Trust ☐ Remittance – Country/ies of
☐ Prepaid Card/Paycard/and Cashier/Gift Check ☐ Time Deposit ☐ Personal Management Destination:
☐ Payroll ☐ Commercial Loans ☐ Asset Management/UITF ☐ Trade Service/Facility - Country of
☐ Private Banking ☐ Credit Card ☐ Escrow/Fiduciary Services Residence/Operations of the
☐ Safety Deposit Box ☐ Cash Management Counterparty/ Intermediary:

Does a US person own, directly or indirectly, more than Expected Frequency of Transaction per month Average amount per Transaction
10% of the stocks of the corporation/partnership (by vote ☐ Five times (5x) or less ☐ Below ₱ 500,000
or value)/profits interests or capital interests in such ☐ Six times (6x) > ten times (10x) ☐ ₱ 500,001 to ₱ 5,000,000
partnership? ☐ Ten times (10x) > fifteen times (15x) ☐ ₱ 5,000,001 to ₱ 20,000,000
☐ Yes ☐ No ☐ More than fifteen times (15x) ☐ Above ₱ 20,000,000, please indicate amount:
Purpose of Account Opening
☐ Payment for Vendor/Supplier/Service Provider ☐ Customer Transactions ☐ Transactions with Parent Company/Subsidiary/Affiliate ☐ Operations-related Transactions
Modes of Depositing Funds
☐ Cash Deposit ☐ Check ☐ Manager’s Check ☐ Online Banking
☐ Remittance:
▪ If cross-border, Country of Origin:
▪ If domestic, City of Origin:
▪ Relationship with Remitter: ☐ Vendor/Supplier/Service Provider ☐ Customer ☐ Parent Company/Subsidiary/Affiliate ☐ Investor/Associate/Employee
Do you have a secondary license or certificate of authority issued by a supervising Secondary License – Designated Non-Financial Business
authority or government agency? and Professions (DNFBPs)

☐ Yes ☐ No
 Does any of the following hold a prominent public Are any of the following, a spouse or partner, child, parent, Is any of the following widely and publicly known, socially
position in the Philippines or any foreign state, OR a grandparent, grandchild, or sibling, whether biological, of professionally, to maintain a particularly close
position in any International Organization? adoptive or by law, of someone holding a prominent public relationship with a PEP, or is in a position to conduct
position in the Philippines or any foreign state, OR a substantial domestic and international financial
☐ Active Authorized Signatory position in any International Organization? transactions on behalf of someone holding a prominent
☐ Director/Trustee public position in the Philippines or any foreign state, OR
☐ Primary Officer a position in any International Organization?
☐ Active Authorized Signatory
☐ Stockholder owning at least 20% of the voting stock
☐ Director/Trustee ☐ Active Authorized Signatory
☐ None
☐ Primary Officer ☐ Director/Trustee
☐ Stockholder owning at least 20% of the voting stock ☐ Primary Officer
☐ None ☐ Stockholder owning at least 20% of the voting stock
☐ None

Name: Name: Name:

Position: Position: Position:

IV. AGENT/AUTHORIZED REPRESENTATIVE (only if applicable)

Name (First Name, Middle Name, Last Name)

Contact Number Nationality

Address

Unit No. Floor Building Name Street Subdivision Barangay City/Municipality Province Country ZIP Code
V. CONFORMITY
By signing below, we confirm that we received and read the terms and conditions governing the various products and services we availed from the Bank as
specified above. We have fully understood and agree to be governed by the provisions thereof. We fully understand and accept the corresponding risks involved in
availing of such banking products, facilities, or services and understand further that our continued use and/or availment of these banking products, facilities, or services
shall mean our conformity to any and all supplement(s), modification(s) or amendment(s) of their corresponding terms and conditions which may be posted in
conspicuous places within the Bank's premises or which may be published by the Bank in any other manner.
We also warrant that we are aware of the provisions of Republic Act No. 9160 (Anti-Money Laundering Act of 2001) as amended, and we represent that our
transactions herein are not among those covered under said law and that our funds come from our legitimate undertakings. We authorize the Bank to make any such
verification or reports in compliance with RA No. 9160, as amended, as it may deem appropriate, for which acts we hold the Bank free and harmless from any and all
liabilities, claims and/or damages.
In case we apply for any credit accommodation, I/we hereby authorize the Bank and its officers and staff to obtain and/or to disclose other parties (including
other banks) information on our deposits and other properties with Metrobank or with other banks.
In compliance with the BSP Manual of Regulations for Banks, I also agree and consent that my/our account may be selected in the regular generation of
Confirmation Letters by Metrobank’s Audit Group to confirm account balances. The Confirmation Letter will be sent directly to our address provided above.

Customer’s Authorized Signatory’s Signature over Customer’s Authorized Signatory’s Signature over
Printed Name / Date Printed Name / Date
VI. DATA PRIVACY CONSENT
☐ By ticking this box, I/We hereby authorize Metrobank to share my personal information and/or sensitive personal information with entities, and for purposes
(a) to commence and to facilitate the administration and operation of the deposit and other Bank products, and the efficient delivery and/or implementation of the
services of the Bank, and (b) in order for the Bank, its affiliates and/or subsidiaries within the Metrobank Group to offer or to provide other related products and
services to the Depositor, including but not limited to cross-referencing, cross-selling, status inquiry, and providing credit opinion and evaluation. I/We authorize
and consent Metrobank to provide information relating to this Account which will include my/our average daily deposit balances for income verification and credit
limit setting purposes necessary in our application to Metrobank Credit Card. I may revoke the authorizations at any time by notifying in writing my branch of
account or by sending an email to dataprotectiondept@[Link]. BY SIGNING THIS FORM BELOW, I authorize Metrobank to receive, store and use
the personal data I provide so they can service my account. I consent with the sharing of my personal data with subsidiaries and affiliates within the Metrobank
Group and agents or third parties that provide services or have contractual obligations with Metrobank.

Customer’s Authorized Signatory’s Signature over Customer’s Authorized Signatory’s Signature over
Printed Name / Date Printed Name / Date
TO BE FILLED-OUT BY THE BANK
Branch Code Branch Name RM/Customer Number

☐ New Customer ☐ Existing Customer ☐ Customer at Branch ☐ Outside of Branch

DECLARATION AND ACKNOWLEDGEMENT
I declare that the face-to-face conduct of KYC as Reviewed Account Opening Documents and Approved by (for High Risk)
prescribed by BSP has been performed. Signature Authenticated/Approved by

Signature over Printed Name of Bank Officer Signature over Printed Name of Bank Officer Signature over Printed Name of Bank Officer

MB-I-M-218.1/Rev. Jan. '25