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INS Enrollment Form September 2020
INS Enrollment Form September 2020
REGISTRATION FORM
Uni t 601 The Pea rl Ba nk Center 146 Va l ero St., Sa l cedo Vi l l a ge, Ma ka ti 1227, Phi l i ppi nes
Marketing: 8843‐8182 Customer Service: 8888‐4674 di a l 1 Fax: (02) 8843‐8160 URL: www.i ntercommerce.com.ph
□ Airline
□ CBW
CLIENT TYPE □ Importer □ Exporter □ Broker □ Forwarder □Shipping □ Trucker
□CY‐CFS
Line
□ Import □ Export
BUREAU OF CUSTOMS □ CPRS □ eManifest □ OLRS □ ABMS
Declaration Declaration
PEZA □ eIPS □ eAEDS □ eLOA □ eZTS
□ BAI □ BFAR □ BPI □ MAV □ NMIS
DEPARTMENT OF
□ SPS IC □ MAVIC □ eRFI □ eCOMI □ ePhyto
AGRICULTURE
□ eREGISTRATION
□ CDC □ FAB □ PPMC □ SBMA
FREEPORT ZONES
□ ETAPS □ EEDS □ eBIBO □ eBPS
TIEZA □ eIPS BOI □ eCAI
COMPANY NAME:
COMPANY ADDRESS:
COMPANY TIN: BOC CCN:
TELEPHONE NUMBER: FAX NUMBER:
TEL NO:
PRESIDENT / GENERAL
MOBILE NO:
MANAGER:
EMAIL ADDRESS:
CONTACT NUMBER &
AUTHORIZED 1.) EMAIL ADDRESS:
CONTACT NUMBER &
PERSONNEL FOR 2.) EMAIL ADDRESS:
REGISTRATION CONTACT NUMBER &
3.) EMAIL ADDRESS:
VASP: InterCommerce Network Services Inc. VASP CCN: VA0000000116
USE OF SERVICE:
Cl i ent wi l l us e the Servi ces i n a ccorda nce wi th a ppl i ca bl e l a w, i ncl udi ng da ta pri va cy l a ws , a nd s ta nda rd condi ti ons of us e es ta bl i s hed by InterCommerce.
InterCommerce wi l l keep Cl i ent Da ta confi denti a l a nd wi l l not di s cl os e to a ny thi rd pa rty wi thout pri or a uthori za ti on. InterCommerce ma y termi na te a cces s or ta ke
other a cti ons i t rea s ona bl y bel i eves to be neces s a ry to compl y wi th the l a w or prevent da ma ge to InterCommerce s ys tems or cus tomers or di s rupti on of other
InterCommerce cus tomers ’ us e of the a ffected Servi ce.
Cl i ent i s a l s o a ccounta bl e for the des i gna ti on of the Us ers a nd the Compa ny’s a va i l ment of the s ervi ce. It i s the s ol e res pons i bi l i ty of the Cl i ent to noti fy
Intercommerce i n wri ti ng on the a cti va ti on or termi na ti on of Us er’s a cces s to the s ys tem. Unl es s Us er ID’s a nd Pa s s words a re termi na ted, us ers , who ma y no l onger
be connected wi th the compa ny or ha ve been rea s s i gned to perform other functi ons , s ha l l conti nue to ha ve a cces s to confi denti a l tra ns a cti on da ta of the compa ny.
Cl i ent a l s o hol ds InterCommerce free a nd ha rml es s from a ny l i a bi l i ty a ri s i ng from a ny a cces s by the Us ers to the s ys tem whether a ri s i ng from the Compa ny or from
thi rd pa rti es .
AUTHORIZED SIGNATORY
(President / General Manager)
SIGNATURE OVER PRINTED NAME DATE
For InterCommerce Use Only:
CLIENT CODE: CS OFFICER:
DATE ACTIVATED: TYPE OF SERVICE: