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BCIF - Ver9 With DPA and Bill Delivery Agreement - 02022022

This document is a business customer information form for an existing customer of SMART to update their customer records. It requests information such as the registered business name, address, contact details, authorized signatories, and billing delivery preferences. The customer agrees to paperless billing and authorizes SMART to obtain personal and credit information for evaluating applications and improving customer experience. It discloses that information will be shared within the PLDT group and partners for facilitating services, product improvement, advertising, and credit investigation. The customer declares the information provided is true and correct.

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322 views1 page

BCIF - Ver9 With DPA and Bill Delivery Agreement - 02022022

This document is a business customer information form for an existing customer of SMART to update their customer records. It requests information such as the registered business name, address, contact details, authorized signatories, and billing delivery preferences. The customer agrees to paperless billing and authorizes SMART to obtain personal and credit information for evaluating applications and improving customer experience. It discloses that information will be shared within the PLDT group and partners for facilitating services, product improvement, advertising, and credit investigation. The customer declares the information provided is true and correct.

Uploaded by

Tegnap Nehj
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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New Customer Customer Records Update (for existing SMART customers)

BUSINESS CUSTOMER INFORMATION FORM


To be filled out by the Customer
Date Accomplished/Signed:
BASIC CUSTOMER INFORMATION
Registered Business Name: Main Telephone No./Trunkline:
Fax No.:
Store/Shop/Outlet Name/Trade Name: Customer's E-mail Address:
Website:
Business Address:

Billing Address (if different from Business Address):

Names of Bill Recipients 1. 2.


Contact numbers of Bill Recipients 1. 2.
Email Address of Bill Recipients 1. 2.
Finance Officer : Finance Officer Contact Number: Finance Officer's Email Address:
Business Ownership: Private Government
Tax Class: VAT Exempt/ Zero-Rated With VAT Others, please specify
SEC Registration No. Company TIN:

Industry Type : Please specify

AUTHORIZED SIGNATORY INFORMATION


Name of Authorized Signatory: Position and E-mail Address: Contact No.[Landline No. & Mobile No.]

ID Presented:
Company ID; ID No. ________________ Passport; ID No. ____________________ Others ________________ ; ID No. ___________
Driver's License; ID No. _____________ SSS/GSIS ID; ID No. ________________
ORGANIZATION DATA
Type of Business (Check only one) SINGLE PROPRIETORSHIP PARTNERSHIP CORPORATION
Date of Registration: No. of Employee(s)/Staff: Years in Operation:
FOR CORPORATION
Key Officers ( indicate the name and position/designation) Contact No. Email Address

FOR PARTNERSHIP - Name of Partners


Name and Position/Designation Contact No. Email Address
1.
2.
3.
FOR SOLE PROPRIETORSHIP
Name of Owner : Date of Birth:
SSS No.: Personal TIN No.: Telephone No.:
Home Address:

FAX No.: Mobile No.: Email Address:


BILL DELIVERY AGREEMENT
YOUR ACCOUNT WILL BE AUTOMATICALLY ENROLLED IN PAPERLESS BILLING AT THE EMAIL ADDRESS YOU PROVIDED.
I/We acknowledge that PLDT/Smart shall send us our Bill within 8-10 calendar days after the Bill Date via electronic mail (email) through the email address I/we specified in this form. PLDT/Smart is deemed to have
validly sent the Bill, and the Bill shall be deemed received at the email address I provided PLDT/Smart. I/We agree to hold PLDT/Smart free and harmless from any liability for my/our failure to receive the Bill despite
it being sent to my/our email address. By Agreeing to receive our Bill via email, I/we understand that I/We will no longer receive a printed copy of my/our bill. Should I/we opt to receive a printed copy of my/our
bill, I/we will course my request through any of the following channels: For PLDT - PLDT Hotline by dialing 177, PLDT Enterprise Facebook, pldtent_cares Twitter account or [email protected] email. For
Smart - [email protected] or [email protected] email.
SOLE PROPRIETOR DISCLOSURE
My signature below signifies that
1. I hereby authorize PLDT INC. and/or any person authorized by PLDT to obtain relevant and pertinent personal information about myself and credit information from the PLDT Group, it's subsididaries, affiliate banks, credit card
companies, and other financial institutions in the course of evaluating my application, and I authorize the release of such information by these companies from which my personal data and credit information are requested. I also consent
to PLDT's disclosure of information concerning myself or my subscription to these companies. I acknowledge that a complete list of the entities under the PLDT Group can be accessed by myself on the PLDT website [
http://www.pldt.com/privacy-policy ]

2. I also hereby authorize PLDT to use and disclose to the PLDT Group and Its subsidiaries and its authorized business partners all information contained in this application including supporting documents submitted, as well as all
information in connection with my subscription, my network/service usage and connections including data about the device/e I use to connect to your service, my payment history/behavior with respect to my subscription, and all
information about myself from your advertisers and business partners, for purposes of (a) facilitating my application for services which they offer; (b) product and service improvement being offered to me by PLDT Group and its
subsidiaries and its authorized business partners; (c)advertising new products and services being offered by PLDT Group and its subsidiaries and its authorized business partners; (d) credit investigation and establishing my credit
worthiness; and(e) improving customer experience.

I hereby declare that all the above information are true and correct to my own knowledge. I hereby authorize PLDT/SMART/SUN to verify any of the above
given information from whatever source it may consider appropriate. Any misrepresentation on the above information shall constitute a just cause for the rejection
of my application or the termination of my contract with the Company.

Authorized Signatory/Signature above Position Date


Printed Name
BCIF_ver9 with DPA and Bill Delivery Agreement _02022022

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