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LinkBiz Portal Merchant Enrollment Form

This document is a merchant enrollment form for LANDBANK Link.BizPortal. It collects information such as merchant name, address, contact details, account profiles, and transaction types and amounts. The merchant and bank representatives must sign the form to agree to the terms and conditions for using LANDBANK Link.BizPortal and certify that the information provided is true and complete. Additional sheets may be attached if needed to provide all required information.

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kuri suchan
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272 views1 page

LinkBiz Portal Merchant Enrollment Form

This document is a merchant enrollment form for LANDBANK Link.BizPortal. It collects information such as merchant name, address, contact details, account profiles, and transaction types and amounts. The merchant and bank representatives must sign the form to agree to the terms and conditions for using LANDBANK Link.BizPortal and certify that the information provided is true and complete. Additional sheets may be attached if needed to provide all required information.

Uploaded by

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

___________________ Branch

LANDBANK LINK.BIZPORTAL MERCHANT ENROLLMENT FORM


New Enrollment Update Information (Pls. specify: ____________) Delete Enrollment
Enrollment Date Merchant Code (for MCMD use)

TYPE OF MERCHANT:
GOVERNMENT INSTITUTION NGA GOCC SUC LGU OTHERS: (Pls. specify _________)

PRIVATE INSTITUTION UTILITIES/ CORPORATIONS/ SCHOOLS COOPERATIVES


SERVICES ENTERPRISES
MERCHANT NAME MERCHANT TAX IDENTIFICATION NO.
- - -
ADDRESS TEL. NO.

ZIP
NO./UNIT NO. BUILDING NAME STREET DIST./BRGY MUN./CITY PROVINCE AREA CODE TEL. EXT.
CODE
LBP SERVICING BRANCH FAX NO.

AREA CODE TEL. EXT.


CONTACT PERSON E-MAIL ADDRESS MOBILE NO.
1 1 1
2 2 2

ACCOUNT PROFILE
BANK USE ONLY
TRANSACTION TYPE TRANSACTION AMOUNT MOTHER ACCOUNT NO. CLEARING ACCOUNT NO.
- - - -
- - - -
- - - -

Note: For Transaction Set, Please use additional sheets, if necessary

FIELD REQUIREMENT FORMAT

1 AMOUNT (default field) mandatory optional alpha numeric alphanumeric Maximum no. of characters: ______

2 mandatory optional alpha numeric alphanumeric Maximum no. of characters: ______

3 mandatory optional alpha numeric alphanumeric Maximum no. of characters: ______

4 mandatory optional alpha numeric alphanumeric Maximum no. of characters: ______

5 mandatory optional alpha numeric alphanumeric Maximum no. of characters: ______

Note: Please use additional sheets, if necessary


I/We hereby agree to the terms and conditions governing the LANDBANK Link.BizPortal.
I/We declare under oath that this LANDBANK Link.BizPortal Merchant Enrollment Form has been accomplished by me/ourselves, and is true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
I/We also authorize the Land Bank of the Philippines and/or its authorized representative to verify/validate the contents stated herein.

Signature Over Printed Name Signature Over Printed Name


Notes: 1. It is the responsibility of the client to inform the Bank should there be any changes in the Merchant Enrollment Form.
BANK USE ONLY
FOR BRANCH FOR MCMD ENROLLMENT
Signature Verified by Checked by: Approved by: Encoded by: Approved by:

Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Distribution: Copy 1: MCMD Copy 2: Merchant Copy 3: LBP Depository Bank
Note: 1. Please write "Not Applicable" or N/A for fields with no applicable date and/or "Nothing Follows" immediately after the last item. Please use additional sheets, if necessary.

Merchant Enrollment Form Page 1 of 1

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