CONFIDENTIAL

Pre-employment Requirements Checklist

Name: Emp. No.: Position:

Division/Department/Unit/Branch: Level:

YES N/A Requirements

Signed Employment Contract

Satisfactory medical / physical exam (Fit-to-work Clearance)

NBI Clearance / Police Clearance and Barangay Clearance

Colored Picture White Background Corporate Attire (2-pcs. - 2x2 and 2-pcs. - 1x1)

Resume with at least three (3) Character References w/ contact details

Photocopy of the following:

Transcript of Records

Birth Certificate (5 copies)

Marriage Contract (5 copies)

Birth Certificate of Dependents (5 copies)

Clearance from most recent Previous Employer (if applicable)

BIR Form No. 2316 of Current Year (if applicable)

Two (2) Valid IDs (e.g. Passport, NBI Clearance, Driver's and PRC License)

Government numbers with supporting documents:

SSS Number (ID / E-1, E-4, E-6 / Online Print)

Philhealth Number (ID)

PAG-IBIG Number (Transaction or Loyalty Card / MDF)
Register online at http://www.pagibigfundservices.com for new members

Tax Identification Number (ID or any BIR Forms - TIN indicated)

Forms to Fill-Out

ID Request Form

Payroll Account Opening Form (Robinsons Bank) - with two (2) valid ID
e.g. Passport, NBI Clearance, Driver's and PRC License

BIR Form No. 1902 (For TIN application)

BIR Form No. 1905 (For transfer of records from previous BIR RDO to registered place of residence)

Pag-ibig Member's Change of Information Form (MCIF)

Philhealth Member's Registration Form (For updating of employer information to Asia United Bank)

Sworn Authorization (Notarized)

Signed acknowledgement of the following:

Manuals / Policies Agreement Form

Code of Conduct and Discipline

Patent and Confidential Information Agreement

Policy on Conflict of Interest

Personal Investment Policy

Drug Free Workplace Policy and Program

Additonal Requirements for Officers:

BSP Forms (Notarized)

Authorization to conduct background investigation

Fit and proper Certification

Biographical Data

Day 1 Regular

Manulife Individual Application for Group Life Insurance

Maxicare Application Form

This is to confirm that this Pre-employment Requirements Checklist has been discussed and I fully understand that failure to submit and / or complete my requirements within probationary
period could mean non-regularization of probationary employment.

Conforme: Received / Noted by:

Employee's Signature over Printed Name Signature over Printed Name

Date: Date:

Updated as of August 2022

 ffil|$JH

understand and agree that the following manualslhandbooks

are intended to be general guide to the
I
rules, policies and procedures of Asia'United Bank'

and agree to be
I herebyacknowledge that I have read and understood the contents ofthese handbooks
bound by the rules, policies and procedures stated in it

1. Employee Handbook (Available at HRIS - ePortal Liqk httn://10.1.&107hris/eeortal0

2. Corporate Governanoe Handbook
3. Information Security Policy Statement

4. Anti-Money Laundering Handbook

Employee' s Printed Name

Employee's Signature

Position Title

Group/D epartment/Unit

Date

-
]oy-Nostalg Center, 17 ADB Ave., Ortigas Center, Pasig City, Philippines
Tel. (632) 638 6888 I 63133331www'aub'com'ph
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ACKNOWLEDGMENT SLIP:

the AUB Co$9 of

This confirms that I have received, read and understood
by the rules' policies and
Conduct and Discipiine anO that I agre" to O" bound
procedures as stated in the policy'

Employee's Printed Name

Employee's Signature

Position Title

Division/Branch/GrouP

Date

t2
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pATENT AIrp.coNEIBENTIAL n*Iron$f,AfPI{'AGRES'}[ENT

Bauk' I agree to
In oonsideration qf rnv position and emnf3y*""i Yi[t.1di1-t]l"A
keep confidenti*, *,ioit to diwlge
to otali during fte bgtus.e of my. emploSrment'
of the Bark' its
a"t"l"g*afig ttre business
secret and ooofra"nti"t"io:fo-rm"iicri ana methods and
customers, u"rvio",, ?uTi;;;-;F9-t'
u"iii"!* 'pitit'ol tTfuthg
strategies,' costs
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and'
se*r"i oip'orir"tv
propriet Tflffitffi
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*iitt'it t.bank terminates' I agree not
to
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"u"nt-,u", "rptoym# and to return promptly to the
divqlge or use ,."1r;;i;#"iin6t1""tion,
Bank'
;;;#""tt and all other materials owned bythe

Inadtlition,itisunderstoodthatwhileemployedbyi:il'PoiludBanlc'Iwiil or
piomptly disctose il;;ig" t,i it my iniurist'in uny initi"tivu' improvemerit
discovery maoe of ffi#;a;t;,
* iqfi,lt with othe$' which afises
"iih;;lo; will assist the Bank
out of ny e'p,oy;;;.-'o1t6 sant'1 ft;;J;d"b*ptot.,I i,, #;di;" witb anv ionhoversv
during rhe period of my em-ploSrrnent Td#;Htt improvement or tliscovery anil
in
or legal prooeeding relatine to such _iiiiiative same' I
La-i[Jbr patent or other protection coveringthe
obtaining domestic

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Print'ed Name

Ddte.:

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'statement Confliot of
I bave rgseived a copy of the outlining the polioy- of Asia Uaited Bank on
and implie4 I am not
Interest and am familiar with its sontents. Witf,in its'meanlng,'expressed
famity nature whictr would
and bave not been aware of any ciroumst*;t f"lt""";i1oi
"i"
conflict with tbo interest of AsiaUnited Bank except as inclicatedbelow'
'

nT'{one" oa the space

Note: If there is nothing to report, pleas.e write
Provicleil above.

oumstanse $thioh may (develop in the firture'

I firrther undertake to report promptly any oiroumstanse'ws.rctr

Employee's Printed Narne

EmploYee's SiPature

Position Title.

Divis ionlBranetr/GrouP

Date'

AUB EmiloylFQntf,€quitomonts
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To : The Chief Compliance Officer

Re : Personallnvestment

to acknowledge that I have received a copy of Asia United BanKs Personal lnvestment Policy. I
This is
hereby certify that I have read and fully understood the Policy and undertake to comply with all of its
provisions and requirements.

Name of Employee

Employee's Signature Date

Department/Group

Noted by
Chief Co m p li a n ce Office r

NOTE: THIS NOTICE MUST BE SENT TO THE CHIEF COMPLIANCE OFFICER BEFORE ANY PERSONAL DEALINGS ARE TRANSAC:TED.
ACKNOWLEDGMENT SLIP:

AUB DRUG.FREE WORKPLACE POLICY AGREEMENT

.

This confirms that I have received, read and understood the

AUB Drug Free Workplace Poliiy and that lagree to be bound
by the rules, policies and procedures as stated in the policy.

Employee's Printed Name

Employee's Signature

Position Title

Division/B ra nch/G rou P

Date
SIGNATURE SPECIMEN CARD
DATE

ACCOUNT NAME ACCOUNT NUMBER

SIGNATURE COMBINATION
This is to authorize ROBINSONS BANK to honor/recognize the following signature/s in the payment of funds or transaction of other business involv-
ing the above Account/Investment.

ALL ANY ONE ANY TWO OTHERS _______________________________

AUTHORIZED SIGNATORIES
CLIENT NAME (Last Name, First Name, Middle Name) EMAIL ADDRESS

AFFIX SIGNATURE

1) 2) 3)

CLIENT NAME (Last Name, First Name, Middle Name) EMAIL ADDRESS

AFFIX SIGNATURE

1) 2) 3)

DEPOSITOR’S AGREEMENT

By affixing the above signatures, I/we authorize ROBINSONS BANK to open __________________________________ Account/Investment. I/We
hereby acknowledge that I/we have read and understood the terms and conditions and other agreements governing the establishment and opening
of above Account/Investment and agree to be bound by said terms and conditions and other agreements. Please consider the above signatures in
the disbursement of funds and other released banking transactions of said Account/Investment.

FOR BANK’S USE ONLY

SIGNATURE TAKEN / AUTHENTICATED BY / DATE APPROVED BY / DATE SCANNED BY / DATE

SIGNATURE COMBINATION

Robinsons Bank Director

Shareholder
ATTACH 1”x1” ATTACH 1”x1”
Robinsons Bank Employee
PICTURE HERE PICTURE HERE
Employee Number: _____________________

Relative of Robinsons Bank Employee

Employee Name: _______________________
Relation: ______________________________ CLIENT NAME CLIENT NAME
(Last Name, First Name, Middle Name) (Last Name, First Name, Middle Name)
Relative of Shareholder
Shareholder Name: _____________________
Relation: ______________________________

REMARKS

SSC_Digitized-Version May 2020

 CLIENT INFORMATION AND AUTHORIZATION RECORD RETAIL
Branch/Unit CIF No. Date

Title Name (Last Name, First Name, Middle Name)* Nick Name(s)

Date of Birth (mm/dd/yyyy)* Place of Birth (Please specify City/Municipality)* Gender* Mother’s Maiden Name (Last Name, First Name, Middle Name)
Male Female

Civil Status Religion SSS/GSIS/TIN/PhilSys No. Citizenship/Nationality*

Single Widowed
Separated Married: Spouse’s Name
Present Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code)* Region* Residence Ownership
Company Provided
Permanent Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code)* Living with Parents/
Preferred Mailing Address
Relatives
Permanent Address
Owned
Statement of Account Educational Attainment
Present Address Rented
Hold Mail Doctoral Degree Bachelor’s Degree High School Diploma
Mortgaged
E-Statement (online banking) Master’s Degree Associate's Graguate Others, please specify:
Work/Business Address

Home Number (Country Code, Area Code, Tel. No.)* Mobile Number(s)* Preferred E-mail Address*

WORK INFORMATION (OR BUSINESS INFORMATION FOR SOLE PROPRIETORSHIP)

Employment Type* Nature of Work/Business*
Employed Agriculture Healthcare Transportation and Communication
Designation/Position Banking Manufacturing Utilities
Construction/Real Estate Mining Wholesale and Retail
Name of Employer
Education Professional Services Others, please specify:
Self-Employed Financial Services
Designation/Position
Name of Business
Retired Gross Monthly Revenue (In Peso or Peso Equivalent)* Source of Income/Funds*
Pensioner
50,000 or less 300,001 to 500,000
OFW 50,001 to 150,000 500,001 to 1,000,000
Unemployed 150,001 to 300,000 1,000,001 and above

Work/Business Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code)* Work/Business Number (Country Code, Area Code, Tel. No.)*

CLIENT’S SPECIAL INSTRUCTIONS

Authority to Debit Account/Transfer of Funds from Acct. No. to Account No. and vice versa
Authority to Roll-Over Placements ( ) Principal plus Interest ( ) Principal Only ( ) Interest Credit to CA/SA #
Other Instructions

In connection with my/our opening of an account/placement with Robinsons Bank Corporation (the “Bank”) and in order for the latter to comply with the “Know Your Customer”
requirements of the Bank, Bangko Sentral ng Pilipinas (BSP), and other laws mandating proper identification of the Bank’s depositors/customers, this shall serve as my/our
formal authorization and consent for the Bank to verify with the Embassy of my nationality as above indicated, the authenticity of my identity as indicated in my passport (the
details of which I/we warrant to be true and accurate) and if such photocopy is insufficient to verify my/our identity, I/we hereby undertake to present my/ourselves as
representatives before the said Embassy. I/We hereby waive any citizenship confidentiality laws for the purpose of allowing the Bank to duly verify my/our identity.

DECLARATION OF BENEFICIAL OWNERS

Account owner/s is/are the beneficial owner/s. (No need to supply the details below.)
Account owner/s has/have other beneficial owner/s. (Supply the details below or provide additional sheet/s, if necessary.)

DETAILS OF BENEFICIAL OWNER (IF OTHER THAN THE ACCOUNT OWNER/S)

Name (Last Name, First Name, Middle Name) Contact Number

Date of Birth (mm/dd/yy) Place of Birth Nationality Nature of Work

Present Address (House/Street No., Street Name, Barangay/Locality, Town, City, Province/State, Country, Zip Code) Source of Funds

Fields with check marks and (*) should be indicated. If not applicable/available, indicate "N/A". CIAR Retail -Version February 2021
For information without (*) which are not applicable/available, indicate "X".
 FATCA REQUIREMENTS
Mandatory for U.S. Citizens, including Dual Citizen/Green Card Holder/Resident Alien
U.S. Registered Address (Building No./Level, Street No./Name, Locality/Town, City, State, Country, Zip Code)* Address Valid Since U.S. TIN (if U.S. Citizen)*
(mm/dd/yyyy)*

Residency*
Resident (e.g. Filipino, sea-based OFW, Aliens with ACR or Special Retirement Visa ID, etc.)
Non-Resident (e.g. Aliens, Filipino immigrants, land-based OFWs with contract to work abroad for an aggregate period of 780 days or more, etc.)
Non-Resident Since (mm/dd/yy)
Resident Country

CLIENT’S CERTIFICATION AND AUTHORIZATION

By agreeing to this form, I/we hereby certify that the information provided herein are true, accurate, and complete. I/we agree to notify/update the Bank of any change in any of the information supplied
in this form.

I/We hereby authorize the Bank to disclose and report to the U.S. Internal Revenue Service (IRS)/Bureau of Internal Revenue (BIR) all relevant and necessary information as required under the Foreign
Account Tax Compliance Act (FATCA), if applicable.

I/We acknowledge to have read, understood and agreed to be bound by all the Terms, Conditions, and Agreements for Opening of Account/Placement/Investment governing the products and
services of the Bank which I/we opened/availed of, which need not be separately executed/signed by me/us it being an integral part of the Client Information and Authorization Record, and were
provided to me/us, received by me/us, and/or available to me/us via www.robinsonsbank.com.ph and/or Bank’s digital channels, as the same may be amended from time to time, subject to the
implementation of appropriate and necessary notice as may be reasonably determined by the Bank or required by law whenever applicable..

I/we acknowledge that I/we have read, understood, and fully agree with above Terms, Conditions, and Agreements for Opening Account/Placement/Investment of Robinsons Bank Corporation. I/
we agree to be bound by the terms, conditions, and agreements applicable to and governing my/our account(s) and/or investment(s), which appear as separate documents relative to said account(s)
and/or investment(s). Said terms, conditions and agreements shall likewise apply to all my/our existing and future account/s and/or investment/s with the Bank. I/We hereby further authorize the Bank
to open additional account(s) and/or investment(s) with the same account title as contained in this account opening form subject to the rule governing the aforementioned account(s) and/or
investment(s) and the terms, conditions, and agreements therein and herein. I/We agree to comply with any and all rules, regulations, and laws pertaining to Anti-Money Laundering measures, laws,
and regulations and hereby unconditionally agree to hold the Bank free and harmless from any and all damages, suits, costs, and expenses related directly or indirectly with its compliance with such
laws and/or regulations.

I/We hereby expressly agree, consent, and authorize the Bank and/or its agents, whether manually or via electronic channels, to process, obtain, collect, record, organize, store, update, modify,
use, access, share, and/or disclose (collectively “Process”), without need of prior notice to me/us, any and/or all information relating to my/our account in order to (a) facilitate, monitor, improve the
quality of or otherwise service my/our account and such products, services, facilities, and/or channels availed of by me/us, and (b) to comply with legal, regulatory, or other obligations of the
Bank under applicable local or foreign laws, rules and regulations that impact the Bank. Such processing may be conducted for the duration, and even after the termination of my/our availment
of the Bank’s products, services, facilities, and /or channels. As used herein, the term “Bank” shall include the Bank’s branches, its parent company including its shareholders, subsidiaries,
affiliates, agents, and third-party service providers. Without limiting the generality of the foregoing consent and authorization, I/we hereby grant the Bank the permission to process information
pertaining to my/our accounts as maybe required under such other rules and regulations which may be issued by the Banko Sentral ng Pilipinas (BSP), Philippine Deposit Insurance Corporation
(PDIC), Philippine Clearing House Corporation (PCHC), Credit Information Corporation (CIC), TransUnion Information Solutions, Inc., National Privacy Commission (NPC), BancNet, Bankers
Association of the Philippines (BAP), Credit Card Association of the Philippines (CCAP), Securities and Exchange Commission (SEC), Bureau of Internal Revenue (BIR), Anti-Money Laundering
Council (AMLC) and Professional Regulations Commission (PRC),or any other credit bureau or regulatory body.

I/We hereby acknowledge that I/we have read, fully understand, consent to and agree to be governed by the attached Privacy Consent and Notice (PCN) as well as the provisions of Republic Act No.
10173 or the Data Privacy Act of 2012.

I/We signify our interest in receiving invites to the marketing initiatives, campaigns, and programs of the Bank, and its parent company including its shareholders, subsidiaries, affiliates, agents
and third-party service providers regarding its/their other products and services. In this regard, I/we hereby authorize the Bank to share my/our personal data/information to its parent company
including its shareholders, subsidiaries, affiliates, agents, and third-party service providers in order to facilitate the sending of invites to me/us. I/We expressly authorize the Bank to notify me/us their
services and other products using electronic communications including among others, SMS, Chat Messaging Service (CMS), Social Networking Service (SNS), and other marketing and
communication channels.

Signed this in , Philippines

INDIVIDUAL JOINT "OR" JOINT "AND" OTHERS:

Signature of Client Over Printed Name and Date Signature of Client Over Printed Name and Date Signature of Client Over Printed Name and Date
(Specimen Signature) (Specimen Signature) (Specimen Signature)

CREDIT CARD

Credit Card UNO Credit Card DOS Others:

By signing the space below provided in this section, I/we hereby apply for Robinsons Bank (RBank) Credit Card and I/we undertake to submit documents as may be deemed
necessary by the Bank. I/We authorize the Bank to conduct random verification with government agencies or third parties to establish the authenticity of the information declared
and/or documents submitted and I/we hereby waive the confidentiality of the rules and laws as applicable. I/We further understand that the issuance of RBank Credit Card shall
be subject to credit evaluation and discretion of the Bank and terms and conditions applicable to RBank Credit Card.

Signature of Client Over Printed Name and Date Signature of Client Over Printed Name and Date

FOR BANK’S USE ONLY

Type of Client Relationship Manager
Walk in BSS Referred/ Introduced by:

Remarks:

Encoded by / Date Approved by / Date

Fields with check marks and (*) should be indicated. If not applicable/available, indicate "N/A". CIAR Retail -Version February 2021
For information without (*) which are not applicable/available, indicate "X".
 PRIVACY CONSENT AND NOTICE

I. Introduction We also have legal obligation to disclose relevant and necessary personal data to government
regulatory agencies in accordance with reportorial requirements established by law.
Robinsons Bank seriously commits itself to the protection of your privacy rights. This Privacy
Consent and Notice (“PCN”) reflects our commitment to ensure that data subjects from whom We will not share or disclose your personal data to unauthorized third parties without your consent
we collect and process financial and personal data about, are adequately informed of the unless we are legally required to do so.
organization’s activities with respect to such data. In relation thereto, we endeavor to obtain
your informed consent to continue processing your personal data under the terms provided We reserve the right to use or disclose any information as needed in order to comply with applicable
hereunder. laws and regulations; to protect the integrity of our system, products and services and in the
provisioning of the same; to fulfill your request; or when required to cooperate in any law
II. Collection/Processing of Personal Data enforcement investigation or in instances involving public safety subject to appropriate procedures
for verification, due diligence, and authentication.
As a condition for the use of Robinsons Bank’s facilities, products and services, we collect
financial and personal data directly from you through your account opening/application and as IV. Retention and Disposition of Personal Data
described through our Terms and Conditions. We process your information only for the
following purposes: We will keep your data only for as long as is necessary for the fulfillment of the declared, specified,
and legitimate purposes mentioned above. After which, we shall dispose of it in a lawful and secure
• Fulfillment, delivery, support, and maintenance of Robinsons Bank facilities, products manner that would keep your personal data from being further processed and/or accessed by
and services; unauthorized parties in accordance with the organization’s retention and disposal policy.
• approve, facilitate, administer and process applications and transactions;
• respond to queries, requests and complaints and improve how we interact with you; In relation thereto, we would like to inform you that it is the organization’s policy to retain the personal
• communicate with you, including sending of your statements and/or billings, data you shared with us, even when the said application with us proves unsuccessful. We maintain
administrative communications about any account you may have with us or about future such application database solely to introduce future offerings better suited for you and/or to process
changes to this privacy statement; additional products and services you may wish to avail.
• design new or enhance existing products and services provided by us;
• perform demographic and behavioral analysis to understand market's needs, wants and V. Your Rights as a Data Subject
trends to be able to improve and recommend suitable products and services;
• personalize the appearance of our websites or mobile app and include location-based 1. The Right to be Informed – This PCN honors your right to be informed of whether personal data
services such as finding the ATMs or branches nearest to you; pertaining to you will be, are being, or were processed, including its disclosure to third parties, if any.
• communicate with you regarding Robinsons Bank’s products and services information, As you will see above, we endeavored: i) to provide you with a description of the personal data we
including offers, promotions, discounts, rewards, advisories, notices, and for collect and process pursuant to purposes enumerated above; ii) to obtain your consent; iii) to explain
personalizing your experience with our various touch points such as branches, ATM, the scope and method of the collection and sharing; and iv) the recipients of the personal data
telemarketing, email, SMS, Chat Messaging Service (CMS), Social Networking Service collected and shared;
(SNS), and other marketing and communication channels;
• perform certain protective safeguards against improper use or abuse of our products and 2. The Right to Object – You shall have the right to object to the sharing of your data. Should there
services including fraud prevention; be any changes in the information provided to you in this PCN, you shall be informed of such
• to utilize data analytics that will help the organization improve and develop customer changes and your consent thereto is to be obtained before such changes are implemented.
experience and assistance;
• comply with our operational, audit, administrative, credit and risk management 3. The Right to Withdraw Consent Anytime – You shall have the right to withdraw your consent to
processes, policies and procedures, the terms and conditions governing our products, this PCN anytime.
services, facilities and channels, Robinsons Bank's rules and regulations, legal and
regulatory requirements of government regulators, judicial and supervisory bodies, tax 4. The Right to Access, Rectification, Erasure and/or Blocking – You shall have the right to
authorities or courts of competent jurisdiction, as the same may be amended or request for a copy of any personal data we hold about you, including the sources from which such
supplemented from time to time; data was collected and to whom the same is shared, if any. You may ask it from us through the
• comply with applicable laws of the Philippines and those of other jurisdictions including contact information provided below and we will provide it in a machine-readable format. You shall
the United States Foreign Account Tax Compliance Act (FATCA), the laws on the have the right to have it corrected or revised if you think it is inaccurate or incomplete, subject to the
prevention of money laundering including the provisions of Republic Act No. 9160 submission of sufficient proof establishing the same. You shall have the right to suspend, withdraw
(Anti-Money Laundering Act of 2001, as amended (AMLA) and the implementation of or order the blocking, removal or destruction of your personal data should you a) discover that it is
know your customer (KYC) process/procedures and sanction screening checks; incomplete, outdated, false, unlawfully obtained, used for an unauthorized purpose, no longer
• comply with legal and regulatory requirements such as submission of data to credit necessary for the abovementioned purposes; b) withdraw your consent thereto; or c) discover
bureaus, credit information companies, the Credit Information Corporation (CIC) violations of your right as a data subject.
(pursuant to RA No. 9510 and its implementing rules and regulations), responding to
court orders and other instructions and requests from any local or foreign authorities VI. Contact Us
including regulatory, governmental, tax and law enforcement authorities or other similar
authorities; If you have any questions or concerns about this PCN or with our personal data processing activities,
• background checks through character reference verification; and please reach us through the following contact information:
• perform other such activities permitted by law or with your consent.
DATA PROTECTION OFFICER
Further, if you already are, become, or apply to become a client of our parent company and/or Robinsons Bank Corporation
any of our subsidiaries and affiliates, Robinsons Bank Corporation including its parent company 17th Floor Galleria Corporate Center
and the subsidiary/ies and/or affiliate/s concerned have the option, but not the obligation, to rely EDSA corner Ortigas Avenue
upon, use, and share your relevant personal data and/or account information for any of the Quezon City Philippines
following purposes:
VII. Amendment
• to facilitate and integrate your account opening or application with the concerned
subsidiary/ies or affiliate/s; Robinsons Bank Corporation may change this PCN from time to time by notifying you the updated
• to validate, consolidate or update your customer information records and/or credit version of the PCN and to secure your consent when necessary. You are also encouraged to visit
history; Robinsons Bank’s official website frequently to stay informed about how Robinsons Bank
• to provide consolidated billings, deposit or investment summaries or other reports as you Corporation uses your personal information.
may request;
• to send you advisories, reminders, announcements, promotions, offers, invitations and VIII. Conformity
other notifications;
• for market and financial research purposes, including sharing of data analytics results to This PCN, with your written conformity below, serves as an indication that you have been fully
design banking, financial, securities and investment or other related products or services informed of Robinsons Bank’s customer personal information processing activities, that you
for your use as well as to improve customer experience and assistance; completely understand the terms thereof, that you freely consent thereto.
• additional background checks through character reference verification;
• to comply with a legal obligation to which Robinsons Bank or the concerned You likewise warrant that you have notified and obtained the consent of any third party whose
subsidiary/ies or affiliate/s is subject. personal data you have shared with us.
III. Personal Data Sharing / Disclosures
Internal Disclosures
We will also encode your personal data into our electronic client database stored in our local
data centers as well as via third-party cloud storage facilities/systems. These data centers and ______________________________________________________
systems are covered by appropriate physical, technical, and organizational measures to ensure
your privacy is adequately protected. Only authorized personnel within the organization are (Full Name and Signature)
allowed access to your data and only for the purposes we’ve mentioned.
Third Parties
We allow access to your personal data to trusted and authorized third-party companies,
businesses and vendors engaged with Robinsons Bank who provide services including, among
others:
1. Cloud storage facilities/systems to meet the Robinsons Bank’s storage management
requirements;
2. Utilize Electronic Communication Services including among others, SMS, CMS, SNS,
email and similar communication channels; and Non-Electronic Communication
channels such as but not limited to printed letter(s) for the intent of customer info
updating, promotions and other related materials.
3. Implementation of protective safeguards against improper use or abuse of our products
and services including the prevention of fraud and all forms of unauthorized access to
your personal and financial services;
4. For fulfillment and support of Robinsons Bank’s contractual obligations in delivering its
products and services to you;
5. Data analytics that will help Robinsons Bank design and develop new or improve existing
products, services, and customer experience and assistance;
6. Services that would assist compliance with Robinsons Bank’s operational, audit,
administrative, credit and risk management processes, policies and procedures, the
terms and conditions governing our products, services, facilities and channels,
Robinsons Bank's rules and regulations, legal and regulatory requirements of
government regulators, judicial and supervisory bodies, tax authorities or courts of
competent jurisdiction, as the same may be amended or supplemented from time to time.
Robinsons Bank will remain responsible over the personal data disclosed to such third parties.
As such, we will ensure that such third parties are contractually obligated to comply with the
requirements of the Data Privacy Act and shall process your data strictly in accordance with the
purposes enumerated above. You may request for additional information on the identities of
these parties from the Office of the Data Protection Officer.

CIAR Retail -Version February 2021

ROBINSO].ISBANK ^",:m'rrfl
A Bonk Commerciol

tr Replacement tr Lost Card tr Re-issued PIN

I certify that all the above stated inforrnation are tr@ .nd €orrect. I turther acknowledge that I have lead and tult undernood the Terms
and co.lditions go\€hinq the us€ of the Robinims Banl D€bit c,rd stated in thl, Deblt cad Aepli(jjgfln

Signaturs ot Cli.nl Olq Pinted N.me and Dato

I I I
over Printed Name / Date /Time ovef P nt€d Name / Date / Time
over Printed Name / Date / nme

o"*\
",",,:1.
over Prlnted Name / Date /Time over Print€d Name / Date / Tihe over P nted Name / Dare / Tihe

TER$S AND CONDITIONS GOVER NG THE USE OF THE ROBI}ISONS BANK CORPORATION
(ROBINSONS BANK) DEBTT CARD
l/We agree and understand that: as discrepancies in the records of lransaction, return it to the Bank w lrcut usinq it. l/We shall
unauthorized transactions, loss or theft of not use the PIN afrer l/,/./e reDorte:d to the Bank
0:ilmPmu$|offi my/our Card, to Robinsons Bank Customer the disclosure of the PIN to anolher person.
Care Center, which in turn shall refer mv/our
1. Onlv mv/our verified Savinos Accrunt and/or comDlaint to the concerned univs ofthe Baik for 9. l/We shall immediately notity the of any
Cufent'Account or Cash- Card under the proper disposition. -Bank
cnanges In my/our personat Intormalton or
Robinsons Bank Account Name shall be update my/our personal information at least
automaticallv enrolled in and accessed throuoh s. l/We acceptfull resDonsibilitv for alltransaciions every lhree (3) years rn acrordance with the
the persodal online bankino facilitv
-(the
-of made with the us'e of mvTour Card (with or requirements of Republic Act No. 9'160, as
Robinbons Bank Corporation 'Bank'), without my/our knowledge'or authority, with or amended (also known as the Anti-Money
where an electronic Statement of Account without mv/our sionature or PIN). All . Laundering Act of 2001)
(eSOA) shall be made available. transactions made usinq mv/our Card sliall be
2. The Bank shall initially assign and provide
deemed bv the Bank as-lranisactions made with
myiour knbwledg€ or authoized by me/us and
mnunuil!8IGUI|II0f
EtGnorEGmttfl
llt
me/us with a ore-qeneraled nin-eteen sha be vatrd and btnding upon me/us.
(19) disit Autdma6d Teller Machine (ATM) Card
Number and a Personal ldentification Number 6. In the event that the Card is lost or stolen or anv i0.l/We will activate and sran mv/our Card throuoh
(PlN) for the ATM Channel. l/we aoree that the PIN is dbclosed to any other person, lAae shall the Bank ATM PIN ehar;qe facilitv. On;e
PIN is strictlv confidential and shiuld not be immediately notify the bank ofthe lo6s, theft, or activated, my/our Card shall iemain aitive until
drsclosed or-divuloed to or shared with anv disciosure togelher wih the parliculars thereof. the Bank redeives a wr,lten reouest from me/us
person under anytircumstances. Withdrawal, for its termination. The Eank mav. however at
any time and for any reason -it deems fit,
Afrer ll,ve have reDorled the lost of the Card or
transfer. deDosd. Davment of funds. and anv disclosure of the PlN. mv/our accouot shall be
other transabtions enlaihno the use ot the Debit permanenty blocked. ll loss of the Card is teIminate this arrangement without prior written
Card (the "Card") shall In ell circums€nces ano ieported io'the Bank bv anv oerson other than notice to me/us. l/we ao'ee and understand that
at all times. whether with or without meius ("Third Partv Reportino"). the accounl
l^r,/e can enroll my/oui account in the Bank's
Cardholder's authorization. be conclusivelv shall be temporsrili blodked. -The Bank shall retail internel banking facility by using my/our
bindinq upon the Cardholder. lmmediatelv attei contac{ mdus within twentv-fow hours from Card Number and PIN
recerving the Debit Card, l/we undertdke to receipt of the report to confiim the loss of the
change my/our Card PlN. such that ltu/e shall be Card and to process the apDlication for its 11.l/vve will visit the the Bank's website (under
the only oerson/s who has,/have knowledoe of replacement, if iequested. l/W6i ahall be liable for Consumer Awareness Proqram) to know more
the sariri. l/we shall hold the Bank freJ and all transactions made Drior to the reoortino of lhe about secunng banktng tiansaclions through
harmless fiom any and all liabilities, claims, lost or stolen Card or of the disclosrire of lhe PIN eteqrontc cnannets_
losses, or causes of action arising tfom my/our
Card PIN being known to any othdr person. 7 The Bank may, In its absolute discretion. issue a
replacement for anv lost or stolen Card. subiect
nil$cilrEIt
flImrlr|mtilDlrflr$
to a card reolacirment fee for eaih C'erd
3 l^tre have read the Terms end Conditions ot the replaced. The Bank may also tssue a new PIN 12.Any transaction effected bv usinq mv/our Card
retail intemet banking facrlrty of the Bank and qpon sflch terms and conditions the Bank may and PIN through any of the Bank's- electrontc
IAA/e understand the nsks accompanying the deem fit
availment of the facility.
channels shall be conclusivelv presumed to
have been done or authorized bV merus ano
L When the lost or stolen Card is recovered bv l^^,e shall be solely responsible ana liable for all
4. l/we shall refer any of my/our complaints, such me/us, l^,ve shall immediately cut it in half and these transactions. l/We shall hold the Bank

free and harmless from any and all losses conversations between me/us and/or mv/our 34. Any transaction efiected'bv
 artstno lrom the transaclons pfesumeo lo De ouly aulno0zeo represenErlve/s ano me Eanx. tnt9uqn tne lgKrwno channets snafi oe -
done 6r authorized bv me/us. concl-usively presumed Io be done or authorized
25.Taoed or recrrded conversations/instruclions by me/us:
13. The Bank shall impose a servi@ c*large br c€sh shall be conclusive evidence of mv/our
withdrarals or balance inquiry made using lhe communication with the Bank and mav be lsed ATM Wrfdrawab bv enterino-point
rnv/our PIN:
ATMS of other netwo{ks. by the Bank as.evidence in any prirceeding, 34.1. Purchase transaciion vra ofsale
judicial or administrative, without incurnng any 34.2. (POS) terminal by signing ihe sales
14. The Bank. bv detautt. shall debit the t'ansaction liabilitv. voucner; or
amount in th6 currencv the accqmt is maintained. Purchase transaction via internel or
In case, the transaction !.r€s made usrp-a _diferenl 26. l/we shall fulv comolv wih and ahde bv f|e 34.3. mail order bv enterino at a minimum
ql|Tency, the preva rm excnange ra[e ol vEa snall provisions of Reputjlii Act M. 8484 (Aacess the card nuilber andtw2.
be used. D_evices Regulatbn Act of | 998) govemirg the use
ol a@ess cEvtces n @mmerqatuansac[ons. 35. The Bank shdl not be resDonsible for the rdusal
1s. The Bank shall imDose an adminisiralive fee for of anv Merdlant Eslablishment to tpnor the
-Neifier
cross-cufrency transactions made via other 27. All terms and conditpns of my/our existing Card. shall the Bank be liable for any
networks' electronic channels. savinqs/current account aoreement(s) wilh the surcharoe colleded bv tre Mer€fiant Establishment
Bank-lnsofar as thev are iot inconsidtent with for a tiansadion and aebited from fie Account.
16. The Bank shall have no obligation to veriry the these Terms and Cohditions shall remain in full
authenucilv ot anv of mv/our transaction/s other force and effect. 36. The Bank makes no representations aboul the
than throu-oh Caid and PIN verificatron. The oualitv of the ooods and services offered bv
authenticatr-on of mv/our Card and PIN shall be 28. These Terms and Conditions shall be governed third 'parties -providrng benefits, such a5
suftcient authority'for the Bank to carry out bv and subiect to the applicable rules and Ciscounts, to m€/us and will not be responsible
my/our transactions through electronic r6gulations 6t the Bangko Sentral ng Pilipinas if the qood/s or servi:e/s is/are in anv wav
channels. {BsP). deficien-t or otherwise unsatisfactory: Ani
comolaint relatino lo anv of the qoods or
17. The Bank shall charge a card replacement fee 29. The Bank mav modifv. amend. or revise the services of the M6rchant Eslablishmeit should
to cover the Drocessino of card reolacement in terms and coriditions aoolicable to anv of lhe be made to and resolved with the Merchant
case of lost dr stolen qard. services provided hereiii ftom time to time by Establishment. Failure to do so shall not relieve
mailing, e-mailing, or delivering a notice of the me/us ftom any obligations with lhe Bank.
18. The Bank shall impose a processing /retneval modific€tions. amendments- or revised terms
fee for every transaction processed if l/We and conditions at the address shown on mv/our GoilPlilfioroilG
notify the Bank of any complaint regarding accounl records and the revised terms'and
mv/our Cad, the Account, and/or transactlons condrtions shall conesDondinolv take efiect. 37. l/we can lodge my/our conplaint txough the Bank's
us'ino the Card. Mv/our continued us; ot :hv electronic Cuslorner Care Cenler, wfiich can be reached at
cliannels thai the Bank mav hereinafter utrlize Tefephone Number: +63(2\637 227 3
19. The printed transactton receipt and the shall constitute as dv/our conclusive E-mail Address: [email protected]. gh, or
displaied output on any electronic device acceDtance of the modificdtions and revised Mailino Address: -24th Floor Robihsons
Drduaed bv the use of mv/our Card and/or PIN aoreement. The Bank mav send anv notice to Eouita'ble Tower. ADB Avenue corner Poveda
lhall serve-as the medid or record of my/our m;/us. includinq. but not'limited to. nohce of Street, Ortigas Center Pasig City, or through
transaction. In case of any disctepancy modifications vie electronic mail, whrch shall be anv Robinsons Bank BLrsiness Cenler.
between mv/our transaction recaipt and the crnsidered as valid and binding notification.
Benk's own-record of transactions maintained
through its computer systems or otherwise. the 30. l/we hold the Bank, its stockholders, direclors, 38. l/we shallbe responsible for promptly reviewing
latter shall prevatl ancl be accepted as officers. emolovees.
- and reDresentatives free all transactions made rsino mv/our Card and
conclusive redord of mv/our transaction/s for all and harmless frorir any and all liabilities, shall report to the Bani noJatei than srxty (60)
purposes and shall bebinding upon me/us. claims, damaqes. and suiis ofwhatever nature, calendardays from posling date. any disctepan-
arisino out ol and/or in connection with the cies. omtsspns. Inaccuractes, or Incorrect
20. Cash withdrawals and inter-bankfund transfers implehentation ofthese Terms and Conditions, entries. l/we shall hold the Bank free and
throuqh the electsonic channels ot the Bank Including any enors inadvertently committed by harmless from any and all loss, damage, or
shallbe subiect to the dailv transaction limit the Bank or any of its representatives and any liability arising from cr incidental to my/our
imposed by the Bank. Bills Payment and other computer-related errors resulting in failure to tailure to immediatelv reDort anv unauthorized
transactions shall be subject to separate effect any payment transaclion that l^'ve may transactions, impropAr ehtries, br other items
transaction limits. undertake via anv electronic channel using reflected in my/our e-Statement.
mv/our Debit Card and PlN.
21. The Bank shall inform me/us of the amount of 39. In order for the Bank to help me/us and resolve
the limits to be imposed, which may be subJect The Bank will not be held liable for anv losses mv/our complarnt as quickly as possible, l/we
to chanoe from time to time. l/We agree that the resultinq fTom circumstances over which it has uriderstand ihat Uwe naed to Drovide the Bank
Bank riav In the future impos€ fees and no contiol. includino but not limited to failure of suflicient informaiion and supporting
charges oh this arrangemenl within..legal and electronic or mechar=nical equipment or commu- documents. which shal depend on the nature of
regulatory lrmlts and l/we nereoy aumorlze me nication lines or other interconnection concem or complaint, within frve (5) banking
Bank to impose said charges accordingly. oroblems, bad weather conditions, days from reporting date. l/we agree and
barthquakes. floods, or other such similar understand ihat failure t) submit the documents
t6Gr6Uit0IlCG0lrTS events beyond its control. within the required time frame shall mean that
the dispute will be considered closed or settled.
22. l/We herebv authorize the Bank to collect, use, 31. These Terms and Conditions and the
process, siore, and update all information, applicable Robinsons Bank Corporation rules 40. The Bank shall conducl an investigatron of the
Dersonal or otherwise, pertaining to my/our and reoulations . constitute the comDlete complaint and commLinicate its findings to
bccounus in relatpn lo the use of hy/our Card aoreeme-nt between me/us and the Bank. lf me/us. lryve agree to frlly..cooperate with any
or anv Droducts. services, or facilities lhat l/we aiv of the Drovision/s under lhese Terms and such Invest€atron by p()vrdlng me necessary o.r
mav Avail from the Bank now or in the tuture. Conditions shall hereinafter be declared reAulred data. IntOrmal,on, an0 OOCUmenIS lI,
l/we likewise authorize lhe transfer and unenforceable, all other remaining provasions after investioation. the Bank finds the
disclosure of such information for any legal shall remain in full force and effect transaction v;lid, l/we shall pay the disputed
purpose and/or in compliance with a lawful amount. includinq a sales slip retrieval fee of
brdbr ot the court or applicable laws, rules and ilrn0urnnltilDG0rDm0rs Five Hundred P6sos 1e6p 500.00) for every
reoulatrons For thrs Dutpose. l/we hereby
wa-ive mv/our riqhts undei Republtc Act No.
r|ltffiHn transactron relrieved in connection wtlh my,four
complaint.
1405 (Ldw on Secrecy of Bank Deposits).
Repubiic Act No. 10173 (Data Privacy Act of 32. The Bank shall initiallv assion and Drovide 4r The Bank shallnotity m€/us regarding the status
2012), and any oiher laws of similar nalure. me/us a pre-generated sixteen' (16) didit debit of my/our complaint \lithin ten (10) banking
card number. a three (3) diqit card verification days ftom receipt of my/our complaint.
tFt!flutl0|$ tt0u$lllx$ value (CW). a three a3J didit card verification
value 2 (CW2). and b perEonal rdentification
23. l/we hereby allow and authorize the Bank, its number (PlN). which can be used at anv
affihates. a6ents. and reoresentalives to otfer member 6ank's ATM or affiliated merchant anil
soeciallv s;lected proddcts and services to l^^re agree not to share and/or divulge any of
me/us through telephone. mail, e-mail, fax. and these information to any person.
sMs.
33. The Card shall only be valid until its expiration
24. lAVe further authorize the Bank to record. store, month. Use of Card bevond the expiration
reolav and communrcate to anv third partv, monlh shall automaticallv be denied.
Signalure of Clidl Ov* Pnni€d Nan€ 6nd Daie
pdrstiint to any laMul purpose. all telephona

AnW vrsA DcAF-Vo'lion June 2018

(To be filled out by BIR) DLN: _________________
BIR Form No.
Republic of the Philippines
Application for Registration
Department of Finance
Bureau of Internal Revenue 1902
January 2018 (ENCS)
For Individuals Earning Purely Compensation Income
(Local and Alien Employee)
- - - 0 0 0 0 0
New TIN to be issued, if applicable (To be filled out by BIR)
Fill in all applicable white spaces. Write “NA” for those not applicable. Mark all appropriate boxes with an “X”
Part I - Taxpayer/Employee Information
1 PhilSys Number (PSN) 2 Taxpayer Type 3 BIR Registration Date
(To be filled out by BIR) (MM/DD/YYYY)

Local Resident Alien Special Non-Resident Alien

4 Taxpayer Identification Number (TIN) 5 RDO Code
(For Taxpayer with existing TIN)
- - - 0 0 0 0 0 (To be filled out by BIR)

6 Taxpayer’s Name
Last Name First Name

Middle Name Suffix 7 Gender

Male Female

8 Civil Status Single Married Widow/er Legally Separated

9 Date of Birth (MM/DD/YYYY) 10 Place of Birth

11 Mother’s Maiden Name (First Name, Middle Name, Last Name)

12 Father’s Name (First Name, Middle Name, Last Name)

13 Citizenship 14 Other Citizenship

15 Local Residence Address

Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

16 Foreign Address

17 Municipality Code
(To be filled out by BIR) 18 Tax Type ,INCOME1TAX, 19 Form Type ,BIR Form1No. 1700 , 20 ATC II,011.
21 Identification Details (e.g. passport, government issued ID, company ID, etc.)
Type Number Effective Date (MM/DD/YYYY) Expiry Date (MM/DD/YYYY)

Issuer Place/Country of Issue

22 Preferred Contact Type Landline No. Mobile Number

Email Address (required)

Part II - Spouse Information (if applicable)

23 Employment Status of Spouse
Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
24 Spouse Name
Last Name First Name

Middle Name Suffix 25 Spouse TIN

- - - 0 0 0 0 0
26 Spouse Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

27 Spouse Employer’s TIN - - -

 BIR Form No. 1902-page 2
Part III - For Employee with Two or More Employers (Multiple Employments) Within the Calendar Year
28 Type of Multiple Employments
Successive Employments (With previous employer/s within the calendar year)
Concurrent Employments (With two or more employers at the same time within the calendar year)
(If successive, enter previous employer/s; if concurrent, enter secondary employer/s )
Previous and/or Concurrent Employments During the Calendar Year
29A Name of Employer

29B TIN of Employer

30A Name of Employer

30B TIN of Employer

31A Name of Employer

31B TIN of Employer

32 Declaration
I declare under the penalties of perjury that this application, and all its attachments, have been made in good faith, verified by me and to the best of my
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority
thereof. Further, I give my consent to the processing of my information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful
purposes.

________________________________________
Taxpayer(Employee)/Authorized Representative
(Signature over Printed Name)
Part IV – Primary/Current Employer Information
33 Type of Registering Office 34 TIN
- - - 35 RDO Code
Head Office Branch Office
36 Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

37 Employer’s Address
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

38 Contact Details
Landline Number Fax Number Mobile Number

39 Relationship Start Date/Date Employee was Hired 40 Municipality Code (To be filled out by BIR)
(MM/DD/YYYY)
41 Declaration Stamp of BIR Receiving Office
I declare under the penalties of perjury that this application and all its attachments, have been made in good faith, verified by me and Date of Receipt
and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as
amended, and the regulations issued under authority thereof. Further, I give my consent to the processing of my information as
contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

_______________________________________ __________________________
EMPLOYER/AUTHORIZED REPRESENTATIVE Title/Position of Signatory
(Signature over Printed Name)
*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)

Documentary Requirements:

For Local Employee: For Alien Employee:

1. Any identification issued by an authorized government body (e.g. Birth 1. Passport
Certificate, Passport, Driver’s License, etc.) that shows the name, 2. Working Permit or photocopy of duly received Application for Alien
address and birthdate of the applicant. Employment (AEP) by the Department of Labor and Employment
2. Marriage Contract, if applicable. (DOLE)

POSSESSION OF MORE THAN ONE TAXPAYER IDENTIFICATION NUMBER (TIN) IS CRIMINALLY PUNISHABLE PURSUANT TO THE
PROVISIONS OF THE NATIONAL INTERNAL REVENUE CODE OF 1997, AS AMENDED.
(To be filled out by BIR) DLN:_____________________
BIR Form No.
Republic of the Philippines
Application for
Department of Finance
Bureau of Internal Revenue
Registration Information
Update/Correction/Cancellation
1905
January 2018 (ENCS)
Fill in applicable spaces. Mark all appropriate boxes with an “X”
PART I - TAXPAYER INFORMATION
1 Taxpayer Identification Number (TIN) 2 RDO Code 3 Contact Number
- - -
4 Registered Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

PART II - REASON/DETAILS OF REGISTRATION INFORMATION UPDATE/CORRECTION

5 Replacement/Cancellation of 6 Other Updates
FORM/S REASON/DETAILS
A. Certificate of Registration (COR) Lost/Damaged Closure of Business
(proceed to Number 8)
Change of Accredited Printer as Requested by Change of Civil Status
B. Authority to Print (ATP) Receipts/Invoices the taxpayer (proceed to Number 9)
Correction/Change/Update of Registration of Update of Books of Accounts
C. Tax Clearance Certificate of Liabilities (TCL1) Information (proceed to Number 10)

D. Taxpayer Identification Number (TIN) Card Others (specify) Avail of 8% Income Tax Rate Option
E. Tax Clearance Certificate for Transfer of Property/ies (TCL2)/
Others (specify)
Certificate Authorizing Registration (CAR)
F. Others(specify)
7 Correction/Change/Update of Registration Information
A. CHANGE IN REGISTERED NAME/TRADE NAME
Registered Name Trade/Business Name
New Registered Name/Trade/Business Name
Old
New
B. CHANGE IN REGISTERED ADDRESS (Old RDO) (New RDO)
Transfer within same RDO Transfer to another RDO From To
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House/Building No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

C. CHANGE IN ACCOUNTING PERIOD (Applicable to Non-Individual) Accounting Start Month Effectivity Date (MM/DD/YYYY)

From Calendar Period to Fiscal

From One Fiscal Period to Another Fiscal Period

From Fiscal to Calendar Period

D. CHANGE/ADD REGISTERED ACTIVITY/LINE BUSINESS

New Registered Activity/Line of Business Effective Date of Change
(MM/DD/YYYY)

E. CHANGE/ADD FACILITY TYPE/DETAILS (attach additional sheet, if necessary)

Additional/New Facility Facility Type*
Facility Type PP - Place of Production BT - Bus Terminal
Facility Code (check applicable facility type) SP - Storage Place RP - Real Property for
.PP .SP WH .SR GG .BT .RP
. .
Others (specify) WH - Warehouse Lease with No
F SR - Showroom Sales Activity
F GG - Garage
Address of Facility
Unit/Room/Floor/Building No. Building Name/Tower

Lot/Block/Phase/House/Building No. Street Name

Subdivision/Village/Zone Barangay

Town/District Municipality/City

Province ZIP Code

 BIR Form No. 1905 – page 2

F. CHANGE/ADD INCENTIVE DETAILS/REGISTRATION

Investment Promotion Agency Number of Years

Legal Basis Start Date (MM/DD/YYYY)

Incentives Granted End Date (MM/DD/YYYY)
Registration/Accreditation No. Registered Activity
From To Tax Regime
Effectivity Date Activity Start Date
(MM/DD/YYYY) (MM/DD/YYYY)

Date Issued (MM/DD/YYYY) Activity End Date

(MM/DD/YYYY)

G. CHANGE/ADD TAX TYPE DETAILS/SUSPEND TAX TYPE/RE-REGISTER TAX TYPE

Form Type ATC Effectivity Date of Change
Suspend/Cancelled Tax Type/s (MM/DD/YYYY)
(to be filled-up by BIR)

Form Type ATC Effectivity Date

Re-register/Added/New Tax Type/s (MM/DD/YYYY)
(to be filled-up by BIR)

H. CHANGE/UPDATE OF CONTACT TYPE

Phone Number Mobile Number Fax Number
Email Address (required)

I. CHANGE/UPDATE OF CONTACT PERSON/AUTHORIZED REPRESENTATIVE

(Last Name, First Name, Middle Name, Suffix)

Position TIN
- - -

J. CHANGE/UPDATE OF NAME OF STOCKHOLDERS/MEMBERS/PARTNERS

(Last Name, First Name, Middle Name, Suffix, If Individual OR Registered Name, if Non Individual)
A
B
C
TIN
A - - -
B - - -
C - - -

8 Closure of Business/Cancellation of Registration

A. CANCELLATION OF TIN
Death As a result of merger/consolidation
Multiple/Identical TIN Others (specify)
Failure to start/commence business (For Non-Individual)
Permanent closure of a branch Effective Date of Cancellation (MM/DD/YYYY)
Dissolution of corporation/partnership

B. DE-REGISTER/CESSATION OF REGISTRATION
Permanent closure of business (head office) of an individual Trade/Business Name

Others (please specify)

Effective Date of Cessation
(MM/DD/YYYY)

9 Change of Civil Status From Single to Married From Married to Single

A. Old Name/Maiden Name (First Name, Middle Name, Last Name, Suffix)

B. New Name/Married Name (First Name, Middle Name, Last Name, Suffix)

C. Spouse Information
Employment Status
of Spouse
Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
Spouse Name (Last Name) (First Name)

(Middle Name) (Suffix) Spouse TIN

0 0 0 0 0
Spouse Employer’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

Spouse Employer’s TIN - - -

 BIR Form No. 1905 – page 3
10 Books of Accounts
Type (Manual or Volume
Type of Books to be Registered Quantity
Loose) From To

Date Registered Permit Number Date Issued (MM/DD/YYYY)

(MM/DD/YYYY)

11 Other Update/Correction (please specify details) For Taxpayer For BIR Use

Effective Date
of Change Approved by:
(MM/DD/YYYY)
REVENUE DISTRICT OFFICER Date
(Signature over Printed Name)
12 Declaration Stamp of BIR Receiving Office
I declare, under the penalties of perjury, that this application has been made in good faith, verified by me and to the best of my and Date of Receipt
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the
regulations issued under authority thereof. Further, I give my consent to the processing of my information as contemplated under the
*Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

____________________________________________________ ______________________
TAXPAYER/AUTHORIZED REPRESENTATIVE/TAX AGENT Title/Position of Signatory
(Signature over Printed Name)

*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)
Documentary Requirements
REPLACEMENT/CANCELLATION E. Change/Add Facility Type/Details
A. Certificate of Registration 1. Appropriate Application for Registration and requirements therein
1. Original Copy of Old Certificate of Registration, for replacement F. Change/Add Incentive Details/Registration
2. Affidavit of Loss, if lost 1. Certificate of Accreditation/Registration from Investment Promotion Agency
3. Proof of payment of Certification Fee and Documentary Stamp Tax - to be submitted before the I. Change/Update of Contact Person/Authorized Representative
issuance of the new Certificate 1. Authorization or Certification issued by Officer enumerated under Section 52 (A) of the Tax Code
B. Authority to Print (ATP) Receipts and Invoices (President or representative and Treasurer or Assistant Treasurer of the Corporation)
1. Original Authority to Print Primary and Secondary Receipts/Invoices J. Change/Update of Stockholders/Members/Partners
2. New Application Form (BIR Form No. 1906), if applicable 1. Amended Articles of Incorporation/Cooperation/Partnership
3. Affidavit of Loss, if lost
C. Tax Clearance Certificate for Tax Liabilities (TCL1) CLOSURE OF BUSINESS/CANCELLATION OF REGISTRATION
1. Affidavit of Loss, if lost 1. Death Certificate, in case of death of an individual;
2. Proof of payment for Certification Fee and Documentary Stamp Tax-to be submitted before the issuance 2. List of ending inventory of goods, supplies, including capital good;
of the new Tax Clearance Certificate 3. Inventory of unused sales invoices/official receipts (SI/OR);
3. TCL1, if for replacement 4. Unused sales invoices/official receipts and all other unutilized accounting forms (e.g., vouchers,
D. TIN Card debit/credit memos, delivery receipts, purchase orders, etc.) including business notices and
1. Affidavit of Loss, if lost permits as well as COR shall be subject for destruction to be witnessed by BIR personnel and
2. Old TIN Card (if replacement is due to damaged card) officials.
3. Marriage Certificate (for change of Family Name)
CHANGE OF CIVIL STATUS
4. SEC Certificate (for Change of Corporate Name) 1. Marriage Contract or Court Order (declaration of nullity of marriage); and
CORRECTION/CHANGE/UPDATE OF REGISTRATION INFORMATION 2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
A. Change in Registered Name/Trade Name
UPDATE OF BOOKS OF ACCOUNT
1. Amended SEC Registration/DTI Certificate; and
1. Photocopy of the first page of the previously approved books
2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
B. Change in Registered Address REGISTRATION OF BOOKS OF ACCOUNTS
FROM OLD RDO A. Manual Books of Account
1. Inventory List of unused principal and supplementary receipts/invoices for destruction if not to be used 1. New sets of permanently bound books of accounts
in the new RDO or request letter for approval of use of the unused receipts/invoices in new RDO B. Manual Loose Leaf Books of Accounts
FROM NEW RDO 1. Permit to Use Loose Leaf Books of Accounts;
1. Photocopy of Amended Articles of Incorporation/Partnership bearing the taxpayer’s new principal 2. Permanently bound Loose Leaf Books of Accounts; and
business address and Certificate of Filing of Amended Articles of Incorporation (only for Non-Individual 3. Affidavit attesting the completeness, accuracy and correctness of entries in Books of Accounts
taxpayers); and the number of Loose Leaf used for period covered.
2. Photocopy of Mayor’s Business Permit; or Duly received Application for Mayor’s Business Permit, if the C. Computerized Books of Accounts
former is still in the process with the LGU; 1. Permit to Use Computerized Accounting System (CAS)/Computerized Books of Accounts
3. Unused principal and supplementary receipts/invoices for re-stamping per approved inventory list by old (CBA) and/or its Components;
RDO; 2. DVDs containing Electronic Books of Accounts and Records. The DVDs should be properly
4. Transfer Commitment Form. authenticated and its labels duly signed by the responsible official(s) of the company who are
C. Change in Accounting Period required to sign the tax returns under the Tax Code, using a permanent marker;
1. Photocopy of the Securities and Exchange Commission (SEC) Certificate of Filing of Amended By-Laws 3. Affidavit attesting the completeness, accuracy and appropriateness of the computerized
showing the change in accounting period. accounting books/records, in accordance with the keeping of books of accounts and records for
D. Change/Add Registered Activity/Line of Business internal revenue tax purposes.
1. Photocopy of Amended Mayor’s Permit or SEC Certificate of Registration if applicable; and
2. Letter Request for temporary use of old receipts/invoices (for business taxpayers) if applicable.
 PMRF
PHILHEALTH MEMBER REGISTRATION FORM
UHC v.1 January 2020

REMINDERS:
PHILHEALTH IDENTIFICATION NUMBER (PIN)
1. Your PhilHealth Identification Number (PIN) is your unique and permanent
PURPOSE:
number.
2. Always use your PIN in all transactions with PhilHealth. REGISTRATION UPDATING/AMENDMENT
3. For Updating/Amendment check the appropriate box and provide details to Preferred KonSulTa Provider
be accomplished and submit corresponding supporting documents.
4. Please read instructions at the back before filling-out this form.

I. PERSONAL DETAILS
NAME NO
MIDDLE MONONYM
LAST NAME FIRST NAME EXTENSION MIDDLE NAME NA ME
(Jr./Sr./III)
(Check i f app li cable onl y)

MEMBER
MOTHER’s
MAIDEN NAME
SPOUSE
(If Married)

DATE OF BIRTH PLACE OF BIRTH (City/Municipality/Province/Country)

(Please indicate country if born outside the Philippines) PHILSYS ID NUMBER (Optional)

m m d d y y y y
SEX CIVIL STATUS CITIZENSHIP TAX PAYE R IDE NTIFICATION NUMBER (TIN) (Optional)
Male Single Annulled FILIPINO FOREIGN NATIONAL
Female Married Widow/er
Legally Separated
DUAL CITIZEN

II. ADDRESS and CONTACT DETAILS

PERMANENT HOME ADDRESS Hom e Phone Number
Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name

(COUN TRY C OD E + AR EA CODE + TEL EPHONE NUM BER)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code
Mobile Number (Required)

MAILING ADDRESS SAME AS ABOVE

Unit/Room No./Floor Building Name Lot/Block/Phase/House Number Street Name Bus iness (Direct Line)

Subdivision Baranga y Municipality/City Province/Sta te/Country (If abroad) ZIP Code E-mail Address (Required for OFW)

III. DECLARATION OF DEPENDENTS (Use additional form if necess ary )

DATE OF NO Chec k if
NA ME MIDDLE MONONYM
BIRT H with
LAST NAME FIRST NAME EXTENSION
(Jr./Sr./III)
MIDDLE NAME RELATIONSHIP
(mm-dd-yyyy)
CITIZENSHIP NA ME Per manent
Disa bility
(Check i f app li cable onl y)

IV. MEMBER TYPE

DIRECT CONTRIBUTOR INDIRECT CONTRIBUTOR
Employed Private Kasambahay Family Driver
Listahanan LGU-sponsored
Employed Government Migrant Worker
4Ps/MCCT NGA-sponsored
Professional Practitioner Land-Based Sea-Based
Senior Citizen Private-sponsored
Self-Earning Individual Lifetime Member
Filipinos with Dual Citizenship / Living Abroad PAMANA Person with Disability
Individual
KIA/KIPO PWD ID No. ______________
Sole Proprietor Foreign National
Group Enrollment Scheme PRA SRRV No. _____________________ Bangsamoro/Normalization
____________________ ACR I-Card No. _____________________
For PhilHealth Use only:
PROFESSION: (Except Employed, Lifetime Members and MONTHLY INCOME: PROOF OF INCOME: Point of Service (POS) Financially Incapable
Sea-based Migrant Worker)
Financially Incapable

This form ma y be reproduce d and is not f or sale Continue at the bac k

 V. UPDATING/AMENDMENT
Please check: FROM TO
Change/Correction of Name
(Last Name, First N ame, Name Extension (Jr./Sr./III) Middle Name)

Correction of Date of Birth

Correction of Sex

Change of Civil Status

Updating of Personal Information/Address/

Telephone Number/Mobile Number/e-mail
Address

FOR PHILHEALTH USE ONLY

Under penalty of law, I hereby attest that the information provided, including the documents I
have attached to this form, are true and accurate to the best of my knowledge. I agree and
authorize PhilHealth for the subsequent validation, verification and for other data sharing
RECEIVED BY:
purposes only under the following circumstances:

 As necessary for the proper execution of processes related to the legitimate and Full Name:
declared purpose;
 The use or disclosure is reasonably necessary, required or authorized by or under the ______________________________
law; and,
 Adequate security measures are employed to protect my information. PRO/LHIO/Branch:

_____________________________

Date & Time:

_________________________________________________ _________________
Member’s Signature over Printed Name Date Plea se affix right
______________________________
thumbmark if unable to write

INSTRUCTIONS

1. All information should be written in UPPER CASE/CAPITAL LETTERS. If the information is not applicable, write “N/A.”
2. All fields are mandatory unless indicated as optional. By affixing your signature, you certify the truthfulness and accuracy of all
information provided.
3. A properly accomplished PMRF shall be accompanied by a valid proof of identity for first time registrants, and supporting
documents to establish relationship between member and dependent/s for updating or request for amendment.
4. On the PURPOSE, check the appropriate box if for Registration or for Updating/Amendment of information.
5. Indicate preferred KonSulTa provider near the place of work or residence.
6. For PERSONAL DETAILS, all name entries should follow the format given below. Check the appropriate box if registrant has no
middle name and/or with single name (mononym).

LAST NAME FIRST NAME NAME EXTENSION (Jr./Sr./III) MIDDLE NAME

SANTOS JUAN ANDRES III DELA CRUZ

7. Indicate registrant’s/member’s name as it appears in the birth certificate.

8. The full mother’s maiden name of registrant/member must be indicated as it appears in the birth certificate.
9. Indicate the full name of spouse if registrant/member is married.
10. Indicate the complete permanent and mailing addresses and contact numbers.
11. For updating/amendment, check the appropriate box to be updated/amended and indicate the correct data.
12. For MEMBER TYPE, check the appropriate box which best describes your current membership status.
13. For Direct Contributors, except employed, sea-based migrant workers and lifetime members, indicate the profession, monthly
income and proof of income to be submitted.
14. For Self-earning individuals, Kasambahays and Family Drivers, indicate the actual monthly income in the space provided.
15. In declaring dependents, provide the full name of the living spouse, children below 21 years old, and parents who are 60 years old
and above totally dependent to the member.
16. Dependents with disability shall be registered as principal members in accordance with Republic Act 11228 on mandatory
PhilHealth coverage for all persons with disability (PWD).
17. The registrant must affix his/her signature over printed name (or right thumbmark if unable to write) and indicate the date when the
PMRF was signed.
 HQP-PFF-049
(V09, 08/2022)
Pag-IBIG MID NUMBER
MEMBER’S CHANGE OF
INFORMATION FORM (MCIF) HOUSING ACCOUNT NUMBER (if applicable)

INSTRUCTIONS
1. This form shall be accomplished in one (1) copy.
2. Accomplish the applicable portions to be changed/corrected only. Indicate N/A if not applicable.
3. Print all entries in BLOCK/CAPITAL LETTERS.
4. Submit duly accomplished form together with required supporting documents to any Pag-IBIG Branch nearest you.
NOTE: Please submit photocopy of the documents depending on the information to be changed. The original or certified true copy of the said document shall be
presented for authentication.
CHECK THE APPROPRIATE BOX/BOXES AND ACCOMPLISH ONLY THE APPLICABLE PORTION/S TO BE CHANGED/UPDATED
Change of Membership Category Change of Marital Status Updating of Heirs
Change/Correction of Name Change of Address/Contact Details Others (Please specify)
Correction of Date of Birth Change of Employment Details _____________________
LAST NAME FIRST NAME NAME EXTENSION (e.g., Jr., II) MIDDLE NAME

1. CHANGE OF MEMBERSHIP CATEGORY

FROM TO

2. CHANGE/CORRECTION OF NAME (Last Name, First Name, Name Extension, Middle Name)
FROM TO

3. CORRECTION OF DATE OF BIRTH

FROM (mm/dd/yyyy) TO (mm/dd/yyyy)

4. CHANGE OF MARITAL STATUS

FROM TO

FOR MARRIED WOMEN

Use Husband’s Surname Use Maiden Name – Husband’s Surname Retain Maiden Name
SPOUSE Last Name First Name Name Extension Middle Name No Middle Name DATE OF BIRTH (mm/dd/yyyy)
(For Married Status)

5. CHANGE OF ADDRESS/CONTACT DETAILS (Please accomplish portions to be changed only)

PERMANENT HOME ADDRESS (Indicate country code if abroad)
Unit/Room No. Floor Bldg. Name Lot No. Block No. Phase No. House No. Street Name Subdivision COUNTRY+AREA CODE TELEPHONE NUMBER

Home

Barangay Municipality/City Province/State/Country (if abroad) Zip Code

Cellphone

PRESENT HOME ADDRESS

Unit/Room No. Floor Bldg. Name Lot No. Block No. Phase No. House No. Street Name Subdivision Business (Direct Line)

Barangay Municipality/City Province/State/Country (if abroad) Zip Code Business (Trunk Line)

Email Address
PREFERRED MAILING ADDRESS
Present Home Address Permanent Home Address Employer/Business Address
6. CHANGE OF EMPLOYMENT DETAILS
EMPLOYER/BUSINESS NAME OCCUPATION

EMPLOYER/BUSINESS ADDRESS EMPLOYMENT STATUS

Unit/Room No. Floor Bldg. Name Lot No. Block No. Phase No. House No. Street Name Subdivision

Barangay Municipality/City Province/State/Country (if abroad) Zip Code DATE EMPLOYED (Month, Year)

7. UPDATING OF HEIRS (Please use separate sheet, if necessary)

LAST NAME FIRST NAME NAME EXTENSION MIDDLE NAME NO MIDDLE NAME RELATIONSHIP DATE OF BIRTH ADDITION/DELETION
(e.g. Jr., II) (Check if applicable only) (mm/dd/yyyy

8. OTHERS (Please specify)

FROM TO

CERTIFICATION
I hereby certify that the information given, and all statements made herein are true and correct. Likewise, I hereby authorize Pag-IBIG Fund to collect record,
organize, update/modify, consult, use, consolidate, block, erase or destruct my personal data as part of my information. I hereby affirm my right to: (a) be
informed; (b) object to processing, (c) access, (d) rectify, suspend or withdraw my personal data; (e) damages; and (f) data portability pursuant to the provision
of R.A. No. 10173 (Data Privacy Act of 2012).

___________________________________ ________________
Signature over Printed Name of Member Date
THIS PORTION IS FOR Pag-IBIG USE ONLY
RECEIVED BY DATE APPROVED BY DATE

THIS FORM MAY BE REPRODUCED. NOT FOR SALE.

 HQP-PFF-049
(V09, 08/2022)

CHECKLIST OF REQUIREMENTS
MEMBER FILING THROUGH A REPRESENTATIVE
A. Change of Membership Category A. Change of Membership Category
▪ Member’s Change of Information Form (MCIF) (1 Original) ▪ Member’s Change of Information Form (MCIF) (1 Original)
▪ Valid ID acceptable to the Fund (1 Photocopy) ▪ Valid ID of both parties (1 Photocopy)
▪ Authorization Letter (1 Original)

B. Change/Correction of Name B. Change/Correction of Name

▪ For Change in name due to Marriage ▪ For Change in name due to Marriage
- MCIF (1 Original) - MCIF (1 Original)
- Marriage Contract (1 Photocopy) issued by Philippine - Marriage Contract (1 Photocopy) issued by PSA/NSO or
Statistics Authority (PSA)/National Statistics Office (NSO) LCRO
or Local Civil Registry Office (LCRO) - Valid ID of both parties (1 Photocopy)
- Valid ID acceptable to the Fund (1 Photocopy) - Authorization Letter (1 Original)

▪ For Change in name (for reason other than Marriage)

▪ For Change in name (for reason other than Marriage) - MCIF (1 Original)
- MCIF (1 Original) - Birth Certificate (1 Photocopy) issued by PSA/NSO
- Birth Certificate (1 Photocopy) issued by PSA/NSO - Court Order granting petition of change of name
- Court Order granting petition of change of name (1 Photocopy) issued by Second Level Regional Trial
(1 Photocopy) issued by Second Level Regional Trial Court
Court - Valid ID of both parties (1 Photocopy)
- Valid ID acceptable to the Fund (1 Photocopy) - Authorization Letter (1 Original)

C. Correction of Date of Birth C. Correction of Date of Birth

▪ MCIF (1 Original) ▪ MCIF (1 Original)
▪ Birth Certificate (1 Photocopy) issued by PSA/NSO ▪ Birth Certificate (1 Photocopy) issued by PSA/NSO
▪ Valid ID acceptable to the Fund (1 Photocopy) ▪ Valid ID of both parties (1 Photocopy)
▪ Authorization Letter (1 Original)

D. Change of Marital Status D. Change of Marital Status

▪ For Single to Married ▪ For Single to Married
- MCIF (1 Original) - MCIF (1 Original)
- Marriage Contract (1 Photocopy) issued by PSA/NSO or - Marriage Contract (1 Photocopy) issued by PSA/NSO or
LCRO LCRO
- Valid ID acceptable to the Fund (1 Photocopy) - Valid ID of both parties (1 Photocopy)
- Authorization Letter (1 Original)

▪ For Married to Single (legally married to reported spouse) ▪ For Married to Single (legally married to reported spouse)
- MCIF (1 Original) - MCIF (1 Original)
- Court Order (1 Photocopy) issued by Second Level - Court Order (1 Photocopy) issued by Second Level
Regional Trial Court Regional Trial Court
- Valid ID acceptable to the Fund (1 Photocopy) - Valid ID of both parties (1 Photocopy)
- Authorization Letter (1 Original)

▪ For Married to Single (due to erroneous encoding) ▪ For Married to Single (due to erroneous encoding)
- MCIF (1 Original) - MCIF (1 Original)
- CENOMAR (1 Photocopy) issued by PSA/NSO - CENOMAR (1 Photocopy) issued by PSA/NSO
- Valid ID acceptable to the Fund (1 Photocopy) - Valid ID of both parties (1 Photocopy)
- Authorization Letter (1 Original)

▪ For Married to Widowed ▪ For Married to Widowed

- MCIF (1 Original) - MCIF (1 Original)
- Death Certificate of the deceased spouse - Death Certificate of the deceased spouse (1 Photocopy)
(1 Photocopy) issued by PSA/NSO or LCRO issued by PSA/NSO or LCRO
- Valid ID acceptable to the Fund (1 Photocopy) - Valid ID of both parties (1 Photocopy)
- Authorization Letter (1 Original)

E. Change of Address/Contact Details E. Change of Address/Contact Details

▪ MCIF (1 Original) ▪ MCIF (1 Original)
▪ Valid ID acceptable to the Fund (1 Photocopy) ▪ Valid ID of both parties (1 Photocopy)
▪ Authorization Letter (1 Original)

F. Change of Employment Details F. Change of Employment Details

▪ MCIF (1 Original) ▪ MCIF (1 Original)
▪ Valid ID acceptable to the Fund (1 Photocopy) ▪ Valid ID of both parties (1 Photocopy)
▪ Authorization Letter

G. Updating of Heirs G. Updating of Heirs

▪ MCIF (1 Original) ▪ MCIF (1 Original)
▪ Valid ID acceptable to the Fund (1 Photocopy) ▪ Valid ID of both parties (1 Photocopy)
▪ Authorization Letter (1 Original)

H. Correction of Place of Birth/Mother’s Maiden Name/Gender H. Correction of Place of Birth/Mother’s Maiden Name/Gender
(Due to erroneous encoding) (Due to erroneous encoding)
▪ MCIF (1 Original) ▪ MCIF (1 Original)
▪ Birth Certificate (1 Photocopy) issued by PSA/NSO ▪ Birth Certificate (1 Photocopy) issued by PSA/NSO
▪ Valid ID acceptable to the Fund (1 Photocopy) ▪ Valid ID of both parties (1 Photocopy)
▪ Authorization Letter (1 Original)

NOTE: In all instances wherein photocopies are submitted, the original or certified true copy must be presented for authentication.
 SWORN AUTHORIZATION

I, , Filipino, of legal age, married/single, and a resident of

, after having been sworn to in
accordance with law, hereby state:

1. I hereby authorize Asia United Bank Corporation (AUB) (the “Bank”), to conduct a
background investigation on myself relative to my application for or appointment or
employment as officer/staff of the Bank , including but not limited to inquiring from the
Watchlist Files of the Bangko Sentral ng Pilipinas;

2. I hereby authorize the Bangko Sentral ng Pilipinas to disclose its findings pertinent to
the aforementioned inquiry on the said Watchlist Files to the Bank;

3. I hereby authorize the Bank to conduct a background investigation relative to my

personal circumstances, including but not limited to my academic and other school
records, barangay or community records, previous employment records, credit or
financial records, bank accounts, criminal or court records, health and hospital records,
family records, business records and social media accounts;

4. I hereby authorize the pertinent institutions, government agencies and/or courts to

disclose to the Bank such requested information as may be necessary for the Bank to
conduct its background investigation on myself; and

5. Relative hereto, I hereby consent to the collection by and release of personal data to the
Bank in relation to the aforementioned inquiries/investigations, and I hereby waive my
relevant rights to confidentiality of information (including but not limited to secrecy of
deposit accounts) to the minimum extent necessary for the Bank to carry out the
aforementioned inquiries/investigations as contemplated under this Sworn Authorization.

This Sworn Authorization takes effect from date hereof and shall remain in full force and effect
until the Bank receives from me a sworn instrument of revocation.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ of ___________, 20____, in
________________ City.

_____________________________
Signature Over Printed Name

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

) S.S.

BEFORE ME, a Notary Public for and in , this ___ day of

____________ 20__, personally appeared exhibiting to
me his/her _____________________________ (valid ID) as follows:

ID Number Issued At Date/Place of Issuance

Doc. No.: ;
Page No.: ;
Book No.: ;
Series of 20 .