ALIFELONG MARKETING AND SERVICES, INC.

CUSTOMER INFORMATION SHEET

Version 1.0 s.2017

Customer Last Name First Name Middle Name

x Individual
 Roamar Cheryl Bering
Business name
 Business
Tax Identification No. AUTHORISED SIGNATORY
Last Name First Name Middle Name

Beneficial Owner Last Name First Name Middle Name

Roamar Cheryl Bering
Contact Details Telephone Fax Mobile Mobile
4950171 n/a 09227727244
Email FB
c.roamar@yahoo.com cherylbering@ymail.com
Current/Business Bldg/Unit Street Street

Address n/a Number n/a

Barangay District/Locality
n/a n/a
City/Municipality Zip Code Province Country (Def. Philippines)
n/a n/a n/a n/a
Permanent Bldg/Unit Street Street

Address ----- Number 2nd Street , Purok Sambag

Barangay District/Locality
(If Individual Customer)
Canjulao Lapu- Lapu City
City/Municipality Zip Code Province Country (Def. Philippines)
LLC 6015 Cebu Phils.
Personal Details, Date of Birth Nationality Source of Funds

Source of Funds,
(mm/dd/yyyy) Filipino
03/23/1977 Remittance
Employment or Name of Employer/Business
Business n/a
(If Individual Customer) Bldg/Unit Street Street
n/a Number n/a
Barangay District/Locality
n/a n/a
City/Municipality Zip Code Province Country (Def. Philippines)
n/a n/a n/a n/a
Telephone Fax Mobile Email
n/a n/a n/a n/a
Nature of
Business Remittance
Signature 1st Copy 2nd Copy 3rd Copy
(Please sign 3 times)

DO NOT FILL UP BEYOND THIS POINT (FOR ALIFELONG INTAKE PERSONNEL ONLY)
ID(s) Presented Primary IDs (Passport/ACR only if Non-Filipino) Secondary IDs
List down ID Type,
Number, Date of Issue,
Date of Expiry
Corporate Papers  DTI Certificate No.,  SEC Certificate No. & Date of Issue Articles of Incorporation
Date of Issue AND Expiry Date Submitted: _________________
Latest GIS, dated ______________ Corporate Secretary’s Authorisation
Date Submitted: _________________ Date Submitted: __________________
Comments Action Taken CUSTOMER ID
 Accept  Deny
Received By Processed By Approved By System Upload By

Date Date Date Date