Customer-Information-Form-Individual - NEW CIF
Customer-Information-Form-Individual - NEW CIF
Customer-Information-Form-Individual - NEW CIF
Blk.66 lot 28 Phase 6-B Purok San Roque 1 Barangay Handumanan Bacolod City Negros Occidental Philippines 6100
House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code
First Name and Suffix (Jr., III) Middle Name Last Name
Civil Status Purpose of Account Opening
✔
Unmarried Widowed Divorced/ Annulled Personal (includes savings, investment, personal remittances [e.g., pension, payroll, allowance])
✔
Married Separated Small Business
Delivery of Monthly Bank statement With Beneficial Owner?
Electronic (i.e., via MBOS) Mail Yes (fill-out Section III of the form) ✔None
Do you hold a prominent public position in the Philippines/ a Foreign State/ an Does any of the following in your family hold a prominent public position in the
International Organization? Philippines or any foreign state, OR a position in any International Organization?
Spouse/Partner
Yes No
✔ Child (biological/adoptive/by law)
Do you maintain a particularly close relationship with a person who holds a prominent Parent (biological/adoptive/by law)
public position in the Philippines/ a Foreign State/ an International Organization? Grandparent (biological/adoptive/by law)
Grandchild (biological/adoptive/by law)
Yes No
✔ Sibling (biological/adoptive/by law)
Do you conduct substantial domestic and international financial transactions on
behalf of a person who holds a prominent public position in the Philippines or any Name: _________________________________________________________________
foreign state, OR a position in any International Organization?
Position: ________________________________________________________________
Yes No
✔
Country of Residence US TIN US Social Security Number US Telephone Number
US Address
House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code
Types of Products and Services to be availed from the Bank
Current/Checking and Savings Account
✔ Treasury Trust
Prepaid Card/Paycard/and Cashier/Gift Check Time Deposit Personal Management
Payroll
✔ Personal Loans Asset Management/UITF
Private Banking Credit Card Escrow/Fiduciary Services
Safety Deposit Box Cash Management Remittance – Country/ies of Destination: ____________________________
Expected Frequency of Transactions per Month Average amount per Transaction
Five times (5x) or less
✔ Ten times (10x) > fifteen times (15x) ✘ Below ₱ 50,000
₱ 500,001 and above, please indicate amount:
Six times (6x) > ten times (10x) More than fifteen times (15x) ₱ 50,000 to ₱ 100,000
₱ 100,001 to ₱ 500,000
Modes of Depositing Funds Job Title/Position
Cash Deposit
✔ Check Manager’s Check Online Banking
Top/Senior Management
Remittance: Manager/Middle Management
If cross-border, Country of Origin: ________________________________________________________________ Rank and File/Clerical
If domestic, City of Origin: ______________________________________________________________________ Overseas Filipino Worker
Relationship with Remitter: Professional/Consultant
Government Employee
Spouse/Partner Parent/Parent-in-Law
Student
Biological/Adopted Child Relative
Self-Employed
Son-in-Law/Daughter-in-Law Others: _______________________________________
Retired/Unemployed
Source/s of Wealth (please check ALL that apply)
Salary/Commission, please choose code from industry list: _____________________________________________________________________
✔ Pension
Business, please choose code from industry list: ______________________________________________________________________________ Sale of Asset
Remittances, please specify country of origin: ________________________________________________________________________________ Winnings
Allowance – Nature of employment/business of the Benefactor, please choose code from the industry list: _______________________________ Interest Income
Donation/Inheritance, please specify the following: (interest through
Name of Benefactor/Donor: ____________________________________________________________________________________________ investment/lease of
Relationship with Benefactor/Donor: _____________________________________________________________________________________ property, et al.)
First Name and Suffix (Jr., III) Middle Name Last Name
Date of Birth (mm/dd/yyyy) Place of Birth Nationality
City/Municipality Country
Address
House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code
Mobile Number Email Address
Source/s of Wealth (please check ALL that apply)
Salary/Commission, please choose code from industry list: _____________________________________________________________________ Pension
Business, please choose code from industry list: ______________________________________________________________________________ Sale of Asset
Remittances, please specify country of origin: ________________________________________________________________________________ Winnings
Allowance – Nature of employment/business of the Benefactor, please choose code from the industry list: _______________________________ Interest Income
Donation/Inheritance, please specify the following: (interest through
Name of Benefactor/Donor: ____________________________________________________________________________________________ investment/lease of
Relationship with Benefactor/Donor: _____________________________________________________________________________________ property, et al.)
Do you hold a prominent public position in the Philippines/ a Foreign State/ an Does any of the following in your family hold a prominent public position in the
International Organization? Philippines or any foreign state, OR a position in any International Organization?
Yes No Spouse/Partner
Child (biological/adoptive/by law)
Do you maintain a particularly close relationship with a person who holds a prominent
Parent (biological/adoptive/by law)
public position in the Philippines/ a Foreign State/ an International Organization?
Grandparent (biological/adoptive/by law)
Yes No Grandchild (biological/adoptive/by law)
Do you conduct substantial domestic and international financial transactions on Sibling (biological/adoptive/by law)
behalf of a person who holds a prominent public position in the Philippines or any
foreign state, OR a position in any International Organization? Name: _________________________________________________________________
Yes No
Position: ________________________________________________________________
IV. AGENTS/AUTHORIZED REPRESENTATIVES (only if applicable)
Name (First Name, Middle Name, Last Name) Contact Number Nationality
Address
House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code
V. CONFORMITY
By signing below, I confirm that I received and read the terms and conditions governing the various products and services I availed from the Bank as specified above. I have
fully understood and agree to be governed by the provisions thereof. I fully understand and accept the corresponding risks involved in availing of such banking products, facilities,
or services and understand further that my continued use and/or availment of these banking products, facilities, or services shall mean my 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.
I also warrant that I am aware of the provisions of Republic Act No. 9160 (Anti-Money Laundering Act of 2001) as amended, and I represent that my transactions herein are
not among those covered under said law and that my funds come from my legitimate undertakings. I 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 I hold the Bank free and harmless from any and all liabilities, claims and/or damages.
In case I apply for any credit accommodation, I hereby authorize the Bank and its officers and staff to obtain from and/or to disclose to other parties (including other banks)
information on my 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 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 my address provided above.
I am doing this:
So that Metrobank, its subsidiaries, and its affiliates, can further secure me from fraud, unauthorized and illegal transactions, and anti-money laundering and terrorist
financing risks,
• So that my data can be used in the settlement of disputes or claims regarding my account(s) through prosecution or the defense of Metrobank or its staff,
• So that my relevant data can be validated, verified, and updated if needed,
• So that I can be offered products and services within the Metrobank Group that are relevant and suitable to me based on my data, and
• So that Metrobank can better perform its obligations to the law, rules and regulations, contracts, or orders from any courts or quasi-judicial and administrative offices.
If I want to access, update, or correct my personal data, or withdraw my consent to use my data as stated in this form, I have the following options:
• Send a letter to my branch of account,
• Email [email protected], or
• Use any of our available e-channels, website or app, if available
If I withdraw my consent to use my data, or if I settle and close my engagements with Metrobank, I am aware that Metrobank has five (5) years to delete and securely
dispose of my data.
Signature over Printed Name of Bank Officer Signature over Printed Name of Bank Officer Signature over Printed Name of Bank Officer
MB-I-M-217/Mar. ‘21