CUSTOMER INFORMATION FORM

FOR BANK USE ONLY

(Individual)
1. PLEASE PRINT ALL INFORMATION AND PROVIDE SPACE IF NEEDED.
DATE 2. IF NOT APPLICABLE PLEASE INDICATE N/A.
MM DD YYYY 3. PLEASE INFORM THE BANK FOR ANY CHANGES IMMEDIATELY.
Full Name
Last Name, First Name, Middle Name

Date of Birth Place of Birth Gender Civil Status

Male Single Divorced Widowed
MM DD YYYY Female Married Separated
Present Address
Number/Street, Barangay/Subdivision, City/Municipality, Province/State

NAME:
CUSTOMER
Country Zip Code Years of Residence
Permanent Address Same as above
Number/Street, Barangay/Subdivision, City/Municipality, Province/State

Country Zip Code Years of Residence

ID’s Presented

TIN

SSS / SSS UMID GSIS Driver’s License Passport Others (pls. specify)

ID Number ID Expiry Date

MM DD YYYY
Contact Information
Telephone Mobile
Number Number
Country Code Area Code Country Code Network Code

E-Mail Other Social Media Account (e.g. Facebook, Twitter etc.)

Nationality Citizenship

Filipino Others (pls. specify) Filipino Others (pls. specify)

Employment Information

Employed Self-Employed Retired Student Others (pls. specify)

Employer Name / Business Name Nature of Work / Profession or Nature of Business / Position (if applicable)

CUSTOMER ID NUMBER:
Number/Street, Barangay/Subdivision, City/Municipality, Province/State

Country Zip Code

Telephone E-Mail
Number Country Code Area Code

Source of Funds
Average Monthly Amount
Allotment Business Commission Donation Financial Products Gaming

Pension Property Salary Others (pls. specify)

USFATCA
(Please fill out the Consent & Authorization
Are you a U.S. person? N.A. NO But with US indicator (please fill out YES for US Persons under US FATCA and W9
the W8-BEN Form) Forms)
Are you interested to avail of the products/services below?

Credit Card SME Loan Internet Banking Mobile Banking

Customer Agreement
By signing this Form, I hereby:

1. certify and affirm that the information given above and in related documents is true, accurate and complete. For this purpose, I authorize PNB to
verify the truthfulness, accuracy and completeness of said information and agree to promptly inform PNB in case of any change in said information;

2. acknowledge to have read, understood, agreed and received the Terms and Conditions Governing the Opening and Maintenance of Accounts,
including those on Data Privacy, which was presented to me upon opening of the Account and which can be accessed in PNB’s website as well as
other terms and conditions governing deposit products, services and/or facilities that I availed or will avail in the future; and

3. acknowledge that the terms and conditions referred to above may be amended from time to time.

Signature Over Printed Name of Depositor / Date NA001.2 Dec‘19

For Bank’s Use Only
Other IDs Presented:
Customer Walk-in Solicited Account Solicited By:
Signature Over Printed Name / Date
Contact:
Referred Name of Referror / Relationship:
PSIC: CRR Code: Account Officer: Processed by:

Signature Over Printed Name / Date Signature Over Printed Name / Date
Verified Against CWS, OFAC / INF & Signature Authenticated by: Approved by:
Documents Verified Against Original by:

Signature Over Printed Name / Date Signature Over Printed Name / Date Signature Over Printed Name / Date Signature Over Printed Name / Date
Mother’s Maiden Name

Spouse Name

Allotment Information

Remitter’s Name

Relationship

By signing this form, I hereby certify that the information given above and in related documents is true, accurate
and complete. For this purpose, I authorize PNB to verify the truthfulness, accuracy and completeness of said
information and agree to promptly inform PNB in case of any change in said information.

Signature Over Printed Name of Depositor / Date

Form No. NA001.2

 SIGNATURE CARD / ACCOUNT INFORMATION FORM
Page of New Account Updating
Account Number
Date
MM DD YYYY
Account Name:

Client Name: (Last Name, First Name, Middle Name)

Product Name:

Please sign three times using black ink. Product Type:

SA CA TD Others

Type of Currency:
PHP USD Others
FRONT

Account Type Type of Signatory

(for Business Account)
Individual * Business Any One All
Joint : OR AND Any Two
* For Individual Accounts you are eligible to enroll your account
in Internet Banking and Mobile Banking.
Customer Agreement
I hereby agree to the use of this Signature Card in
accordance with the terms and conditions governing the
product, facility and/or services I availed and will avail in
the future. I acknowledge that such terms and conditions
may be amended from time to time.
G001.3 July'19

Statement Disposition
Electronic Mail/Softcopy to preferred Pick-up (on Demand) at the
Email address Branch

Purpose With Correspondence?

(Please specify reason)
Yes No
Customer Instruction Upon Maturity of Time Deposit
Automatic Renewal of Principal + Interest Full Redemption on Maturity Date

Automatic Renewal of Principal. Interest will be Others___________________________________

credited to Affiliate Account
Affiliate Account where proceeds will be credited:
BACK

For Bank Use Only

SSS /
ID/s Philsys GSIS Others
SSS UMID
presented: Driver's
License Passport
ID Expiry Date:
ID Number : MM DD YYYY

Signature Taken by: Signature Verified by: Processed by:

Signature Over Printed Name / Date Signature Over Printed Name / Date Signature Over Printed Name / Date
Verified Against CWS / Documents Verified Against Approved by:
Dowjones by: Original and BBS / BBI by:

Signature Over Printed Name / Date Signature Over Printed Name / Date Signature Over Printed Name / Date Signature Over Printed Name / Date