Beneficial Owner / Business Owner / Signatory / Officer Information Sheet

Please write in BLOCK LETTERS and completely fill out all details, placing NA if Not Applicable

CIF Number
(for bank’s use)

Full Name
Last Name First Name Middle Name Suffix

CONTACT INFORMATION

Personal Mobile Number Personal Email Address Home Landline Number

Country Code Mobile Number Country + Area Code Landline Number

Home Address
Unit No. Building / No. Blk. Street Subdivision / Village / Barangay

City / Municipality Province / State Country Zip Code

PHILIPPINES

Work / Business Email Address Work / Business Landline Number

Country + Area Code Landline Number Local

Work / Business Address

Unit No. Building / No. Blk. Street Subdivision / Village / Barangay

City / Municipality Province / State Country Zip Code

Permanent / Alternate Address (If applicable and for foreigners to provide an address in their country of citizenship) Same as Home Address
Unit No. Building / No. Blk. Street Subdivision / Village / Barangay

City / Municipality Province / State Country Zip Code

PERSONAL INFORMATION

Date of Birth (mm/dd/yyyy) Country of Birth Citizenship (If ‘Others’, please indicate)

Filipino

Others

FINANCIAL INFORMATION
(Refer to ‘Instructions’ for ‘List of Codes’ for ‘Source of Funds’ and ‘Nature of Work / Business’)

Source of Funds (Provide all applicable ‘Codes’) Nature of Work / Business (Provide all applicable ‘Codes’)

Name of Primary Employer / Business

Position / Job Title Gross Monthly Income (PHP)

For Private / Self-Employed Owner / Director / Officer Non Officer NA

For Government Employed Elected / Appointee Others NA

 Beneficial Owner / Business Owner / Signatory / Officer Information Sheet

Do you hold a position in If yes, indicate the ‘Company Name’ and ‘Position’ below
any of the top corporations? Company Name Position

Yes No

Do you have existing If yes, indicate the ‘Branch’, ‘Account Name’ and ‘Account Number’ below
accounts in BDO? BDO Branch Account Name Account Number

Yes No

REGULATORY REQUIREMENTS

FATCA Questionnaire (Refer to ‘Instructions’ for details on the ‘Substantial Presence Test’)

Are you obligated to pay taxes to the U.S. IRS because of your citizenship, residency, or other reasons such as meeting Yes No
the ‘Substantial Presence Test’? If ‘Yes’, accomplish the ‘FATCA Due Diligence Form’
Political Relations and Affiliations Questionnaire
Are you related to or affiliated with a Government Official in the Philippines or in another country? Yes No
If ‘Yes’, accomplish the ‘Political Exposure Form’

CONFORME Signature Date Signed (mm/dd/yyyy)

By signing, I hereby certify that the information given in this application is true and correct to
the best of my knowledge and I undertake to advise the bank and provide documentation for
any changes on the above information.

Valid IDs Presented

Type of ID ID Number Date / Place Issued Expiry Date
FO R BA N K’S U SE ONLY

Residency RC NLDS NLDS Verification Result

Resident N

Non-resident H

Approved By
Name Signature Date (mm/dd/yyyy)

BDO Unibank, Inc. is regulated by the Bangko Sentral ng Pilipinas.

Tel. No.: (02) 8708-7087; Email: consumeraffairs@bsp.gov.ph.
The BDO, BDO Unibank, and other BDO-related trademarks are owned by BDO Unibank, Inc.