ci-business-2014-07-01
ci-business-2014-07-01
NOTES: 1. PLEASE PRINT ALL INFORMATION. 3. IF NOT APPLICABLE PLEASE INDICATE N/A.
2. ALL FIELDS WITH ASTERISK (*) ARE REQUIRED. 4. PLEASE INFORM THE BANK IMMEDIATELY FOR ANY CHANGES.
BUSINESS INFORMATION
Name of Business*:
Business Address*:
CUSTOMER NAME:__________________________________________________
Telephone Number*: Fax Number: Email Address*:
Other Social Media Accounts (e.g. Facebook, Twitter, etc.) : Mobile Number*: Tax Identification Number*:
Date of Registration (MM-DD-YYYY)*: Business Registration Number*: Registration Expiry Date (MM-DD-YYYY):
Single Proprietorship Government Non-Financial Corp. Local Government Units - Provincial Thrift Bank
Private Non-Financial Corporation Local Government Units - City Commercial Bank Financial Intermediaries
Government Financial Corporation Local Government Units - Municipality Universal Bank OBUs (Offshore Banking
Units)
FIRM SIZE
Medium (assets of P15,000,001 but not more than P100,000,000) Large (assets of more than P100M) Others..........................................
SIGNATORIES INFORMATION
FOR U.S. PERSONS UNDER FOREIGN ACCOUNT TAX COMPLIANCE ACT
The Foreign Account Tax Compliance Act (“FATCA”) enacted by the U.S. government in March 2010 and which amended the U.S. Internal Revenue Code, is part of the U.S.
government efforts to improve tax compliance of U.S. taxpayers with foreign financial assets and offshore accounts.
• U.S. entity
• U.S. residence
• A Partnership, Corporation or Association created or organized in the US or under laws of the U.S.
• U.S. telephone number
• Has a “care of” address, a “hold mail” address, or a U.S. Post Office address that is the sole address on file with respect to the account holder.
• Has granted Power of Attorney to a person with a U.S. address.
• Has provided Standing Instructions to transfer funds to an account maintained in the U.S. or directions received from a U.S. address.
For further information on FATCA, you may visit the following websites: www.irs.gov; www.treasury.gov; www.pnb.com.ph
FOR U.S. PERSONS UNDER FOREIGN ACCOUNT TAX COMPLIANCE ACT
U.S. Business Address (Floor, Number, Street, City, State, Postal Code)
W-9 Form
U.S. Social Security Number (For Sole Proprietor): U.S. Employer Identification Number (For Corporation):
Form NA002
List of Substantial U.S. Owners
With respect to any corporation, any specified U.S. person which owns directly or indirectly more than 10% of the stock of such corporation with respect to any partnership, any
specified United States person which owns directly or indirectly more than 10% of the profits, interest, or capital interest in such partnership.
Name (Last Name, First, Middle Name): U.S. Permanent Address Social Security Number
1.
2.
3.
4.
CUSTOMER’S AGREEMENT
By signing this form, the ACCOUNTHOLDER hereby certifies and affirms that the information given above is true, correct and updated. The ACCOUNTHOLDER hereby allows
PNB to verify said information and agrees to inform PNB of any change in the information provided above.
The ACCOUNTHOLDER hereby acknowledges to have read, understood and agreed to the terms and conditions governing the deposit products, services and facilities of PNB
which the ACCOUNTHOLDER has availed of or shall, in the future, avail from PNB. The ACCOUNTHOLDER agrees to be bound by the terms and conditions thereof as well as
to such relevant laws, rules and regulations governing the said deposit products, services and facilities. The said terms and conditions, including the applicable service and
maintenance fees, were provided to the ACCOUNTHOLDER and are available via www.pnb.com.ph.
For purposes of compliance with relevant laws and regulations issued by appropriate regulatory authorities and agencies of the Philippines and such other countries having
jurisdiction over the ACCOUNTHOLDER, the ACCOUNTHOLDER hereby authorizes PNB, its branches and agencies, and all of PNB’s subsidiaries, affiliates or correspondent
banks to access all information relating to the ACCOUNTHOLDER’s PNB deposit account/s, (where applicable) disclose the ACCOUNTHOLDER’s financial accounts to the US
lnternal Revenue Services as required for participating financial institutions under the US Foreign Account Tax Compliance Act (FATCA) due diligence rule, and disclose such data
and papers pertaining to the ACCOUNTHOLDER’s deposit accounts as may be required by government regulatory authorities, here and abroad, conformably with law.
IDs PRESENTED: VERIFIED AGAINST CWS: VERIFIED AGAINST OFAC / INF: DOCUMENTS VERIFIED AGAINST ORIGINALS BY:
FOR BANK USE ONLY
The service fees/penalty charges shall be in accordance with existing 20. DISCLOSURE OF INFORMATION. The ACCOUNTHOLDER
regulations of the BANK. The fees/charges under items (a), (b) or (c) shall be acknowledges that the Philippine Government, United States Government, and
automatically debited by the BANK from the affected Deposit Account governments of other foreign jurisdictions where transactions pertaining or
(regardless of whether the Deposit Account is owned singly, or a corporate incident to the Deposit Account may transpire, may require the BANK, its
account or is an Or Account or And Account of the ACCOUNTHOLDER). In case branches and agencies, and all of the BANK’s subsidiaries, affiliates or
the affected Deposit Account is insufficient to answer for the fees/charges, correspondent banks to disclose or produce information concerning the Deposit
the BANK shall deduct the said amounts from the other Deposit Accounts of the Account. For purposes of compliance with such governmental requirements,
ACCOUNTHOLDER with the BANK. The ACCOUNTHOLDER hereby authorizes the ACCOUNTHOLDER hereby waives his/her/its rights under Republic Act
the BANK to debit the said fees/charges from the affected Deposit Account or 1405 (Law on Secrecy of Bank Deposits), Republic Act 6426 (Foreign Currency
the other Deposit Accounts of the ACCOUNTHOLDER with the BANK. Deposit Act of the Philippines), RA 8791 (otherwise known as the General
Banking Law of 2000), or any other pertinent law or regulation, as the same
The fees/charges under items (d), (e), (f) or (g) may either be paid directly by may be amended from time to time, and hereby authorizes the BANK, its
the ACCOUNTHOLDER to the BANK or deducted from the Deposit Account. In branches and agencies, and all of the BANK’s subsidiaries, affiliates or
case of automatic debit of the said fees/charges, the provisions of the foregoing correspondent banks, without prior notice or reference to the
paragraph shall apply. ACCOUNTHOLDER, to make any and all disclosure of information regarding
the Deposit Account as may be required by the Philippine Government, the
15. AVERAGE DAILY BALANCE. The ACCOUNTHOLDER shall maintain, United States Government or such other foreign governments. The
at all times, the required minimum monthly Average Daily Balance (ADB) relative ACCOUNTHOLDER hereby holds the BANK, its directors, officers, employees
to the Deposit Account. and other duly authorized representatives free and harmless against any and
all liability arising from any loss or damage which the ACCOUNTHOLDER may
The BANK shall notify the ACCOUNTHOLDER, by registered mail on his/her/ incur or suffer as a result of such disclosure.
their address of record, of the dormancy of the Deposit Account at least sixty
(60) days prior to the date of dormancy and the possible imposition of dormancy 21. TRANSFER OF INFORMATION. The ACCOUNTHOLDER hereby
fee in case the Deposit Account is not updated. consents to and authorizes the transfer, disclosure and communication of any
information relating to the Deposit Account or any information thereon, or any
The BANK shall likewise notify the ACCOUNTHOLDER of any changes in the of the ACCOUNTHOLDER’s properties or investments with the BANK to any of
required minimum monthly ADB and the imposition of service and maintenance the offices, branches, subsidiaries, affiliates, agents and representatives of
fees in case of non-updating, at least sixty (60) days prior to the imposition of the BANK and third parties selected by any of them, wherever situated, for
said fees or charges. Said notice shall be delivered to the ACCOUNTHOLDER’s use (including in connection with the provision of any service or product
address as appearing in the records of the BANK through regular mail, electronic relating to your accounts, properties or investments and for data processing
mail, statement of account messages, courier delivery or other alternative and storage, anti-money laundering monitoring, review and reporting, statistical
modes of communication. Failure of the ACCOUNTHOLDER to inform the BANK and risk analysis, and risk management purposes). In addition, the BANK and
of his/her/their objections to the imposition of service and maintenance fees any office, branch, subsidiary, affiliate, agent, representative or third party
within thirty (30) days from receipt of said notice shall be deemed an acceptance may transfer and disclose any such information as may be required by any
of the imposition of such fees and charges. law or regulation.
The cost of said notification shall be for the account of the ACCOUNTHOLDER The ACCOUNTHOLDER hereby holds the BANK free and harmless from any
and shall be debited by the BANK from the Deposit Account. liability that may arise from any transfer, disclosure or storage of information
made pursuant to this provision.
16. UNCLAIMED BALANCES. Pursuant to Act 3936 as amended by PD
679 of April 2, 1975, all unclaimed balances held by the BANK in favor of any 22. NON-RESIDENTS WITH PESO ACCOUNTS. Non-residents may open
person known to be dead or who has not made further deposits/withdrawals a Peso Deposit Account subject to approval by the BANK and to applicable
for a period of ten (10) years or more shall be transferred to the credit of the laws and regulations of the Republic of the Philippines, including those requiring
Republic of the Philippines. all Peso Deposit Accounts by non-residents to be funded only by inward
remittances of foreign exchange or the proceeds of conversion of properties
17. STATEMENT OF ACCOUNT. A statement of account shall be sent by located in the Philippines. The ACCOUNTHOLDER shall be responsible for and
the BANK to the ACCOUNTHOLDER. Except as otherwise provided hereunder assume any and all taxes with respect to the Peso Deposit Account that may
or under the separate agreements covering specific deposit accounts, the be required under applicable laws and regulations. Any outward remittance of
ACCOUNTHOLDER shall be deemed to have received the statement of account funds from the Peso Deposit Account shall comply with applicable Philippines
or has accepted the correctness of the entries made therein or deemed to laws, rules and regulations.
have waived any claims against the BANK if after the lapse of fifteen (15)
days from the date of receipt of such statement of account, the BANK does not A non-resident ACCOUNTHOLDER shall: (ii) provide his/her taxpayer
receive any written notice to the contrary from the ACCOUNTHOLDER. Unless identification number in the country where he is a citizen or a legitimate resident;
the pick-up option is specified, the statement of account will be mailed to the and (iii) comply with documentation requirements for opening a deposit account
ACCOUNTHOLDER. per the regulations of his/her country. The ACCOUNTHOLDER further declares
under penalties of perjury that: (i) the taxpayer identification number provided
The ACCOUNTHOLDER shall promptly notify the BANK in writing of any change by the ACCOUNTHOLDER is true and correct; and (ii) the ACCOUNTHOLDER
of address, failing which the BANK’s notices to the address on record shall be waives any bank secrecy, privacy or data protection rights related to the
deemed sufficient. Deposit Account.
In case an ACCOUNTHOLDER opts to pick-up his/her/their Statement of Accounts 23. NOTICE. All communications and notices required to be given to the
(SOA) from the BANK, the ACCOUNTHOLDER shall pick-up the SOA within ACCOUNTHOLDER shall be personally delivered or transmitted by postage
thirty (30) days from the statement date. prepaid registered mail, by telefax or by electronic mail to the ACCOUNTHOLDER
at his/her/its address appearing in the Account Opening Form or such other
Failure on the part of the ACCOUNTHOLDER to notify the BANK of any change address that may hereafter be given in writing by the ACCOUNTHOLDER to the
in his/her/its/their address or to pick-up the SOA within thirty (30) days from BANK. Except as otherwise specified herein, all notices shall be deemed
statement date shall authorize the BANK to dispose the SOA including the received by the ACCOUNTHOLDER: (a) if delivered personally, upon delivery;
supporting document/s after the required six (6) months retention period. (b) if sent by postage prepaid registered mail, the date five (5) days after
posting; (c) if sent by facsimile transmission, upon receipt of the facsimile
18. AUTHORITY TO WITHHOLD, SELL AND/OR SET-OFF. The Bank is transmission report; or (d) if sent by electronic mail, upon successful
hereby authorized to set-off or withhold as security for any and all obligations transmission of the message based on the e-mail record ofhe
with the Bank, all monies, properties or securities of the ACCOUNTHOLDER BANK.
now in or which may hereafter come into the possession or under the control
of the Bank, whether left with the Bank for safekeeping or otherwise, or come 24. BINDING EFFECT. These terms and conditions are binding on each
into the hands of the bank in any way, for so much thereof as will be sufficient and all of the ACCOUNTHOLDERS and their respective heirs, executors,
to pay any or all obligations incurred by the ACCOUNTHOLDER under the Deposit administrators and assigns.
Account or by reason of any other transactions between the same parties
now existing or hereafter contracted, to sell in any public or private sale any of 25. GOVERNING LAW. These terms and conditions shall become
such properties or securities of the ACCOUNTHOLDER, and to apply the effective upon the opening of the Deposit Account and shall be deemed to
proceeds to the payment of any of his obligations heretofore mentioned. have been made under and shall be governed by the laws of the Republic of
the Philippines, in all respects, including without limitation, matters of title,
19. ANTI-MONEY LAUNDERING. The Deposit Account is further subject construction, validity, performance and discharge and shall not be waived,
to the provisions of Republic Act No. 9160, otherwise known as the “Anti- altered, modified, or amended as to any of its terms or provisions except in
Money Laundering Act of 2001”, including any and all amendments, rules or writing duly signed for and on the BANK’s behalf. In the event that any provision
regulations pertaining thereto. The ACCOUNTHOLDER hereby agrees to keep of these terms and conditions, the Supplements or the passbooks shall be
the BANK, its directors, officers and employees, free and harmless from any declared invalid, illegal or unenforceable by competent court, the other
and all liabilities for any action it has taken or for refraining from taking any provisions of these terms and conditions, the Supplements or the passbooks
action in compliance therewith. not affected thereby shall remain valid and enforceable.
The ACCOUNTHOLDER and any person making a deposit or remittance to the
Deposit Account or the Beneficiary of the Deposit Account (hereinafter
collectively referred to as “Accountees”) warrant that their accounts of
whatever nature such as but not limited to remittances, deposits, investments
or trust accounts (hereinafter the “Account” irrespective of number) shall not
be utilized for money laundering activities nor for funding terrorism and that the
funds thereof, including all increments and additions thereto, shall not emanate
from illegal/or criminal activities or sources.
Any rule or law to the contrary notwithstanding, the Accountees agree that
regulatory authorities of the Philippines as well as all countries where the
funds or money originate or be remitted may conduct reasonable examination
of the Deposit Account or otherwise require submission of pertinent data and
papers for the purpose of removing any doubt and suspicion that the Deposit
Account is involved in money laundering activities or terrorist financial activities
or other illegal activities. Accountees allow, consent, permit and authorize the
BANK and its branches, agencies and instrumentalities to participate in any
such examination, investigation or inquiry and to submit pertinent data and
paper relevant to the objectives of such examination or inquiry.
For this purpose, the BANK and its branches, agencies and instrumentalities
are authorized to disclose such data and papers as required by regulatory