e ° PRODUCERS SAVINGS BANK CORPORATION A Thrift Bonk | 119 APPLICATION AND AGREEMENT FORM lisstpb: Inatattne Einraneertstninn CL] imation po 3 Tlontretenen fava et ee rare ier pence paren PouTeece _« MAGAT 08 AS a | fmeainn/ Rakion. svn. crineoirarnad tee BUBB jonowe = [baer Se. Caries Sy WHER Ceasn Spenber 21, 194% | Calanerbron Cy wee mp [anton Zomion VN unasar | Chie Cverenrany octet Renee $7). Orin ey HUEA Eble ja von ipa — | SESS Stns enters toe bak) need an ash pour ng bepres cnn oe nrc mr, vee oy sganveion 9 ON 19. aw. 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DOMME Reeser Sete Scanned with CamScannerPRODUCERS BAN Coase nize nu-tieh WNT) are VoL Ua eee ule aoa Bh Pet or Td ACCOUNT NAME LAST NAME FIRST NAME MIDDLE NAME Renew Poustice UmAGas— —|New ul necro FE oat [on ane TSI ICSI PERMANENT ADDRESS / PLACE OF BUSINESS NATIONALITY RESIDENCE TEL. NO. (5) (NUMBER, STREET, CITY/MUNICIPALITY/PROVINCE] Clrra| 4 D7) BAe 6%. Comin NE SOURCE OF FUNDS DATE OF BIRTH/INCORPORATION S 4m Kk mboer Lf (293 TNITIBL DEPOSIT PIACE OF BIRTH Z, 75 ane hy STEN SYD Qn. 22 ALG (HUMBER, STREET, CITY/MUNICIPALITY/PROVINCE) E-MAIL ADDRESS/CELLPHONE NO. | TAX IDENTIFICATION NUMBER ee S77? ~ 3318 “3 | ASS Of ~ CA | poe eee Teor ON ns expiay pare Pacip* 2a Zea Sey 20¢9 2 Bitte Se: Domingo S4EVH Emezo¥MGT 32 ¢/9 AONE : ZIP CODE OCCUPATION = ‘OFFICE TEL. NO. (5) 4erva 3/33 SR3__| Texetex-/ one NAME OF EMPLOYER DEP- BQ NueV Eas aan ean DATE OPENED OFFICER'S | DATE DORMANT) OFFICER'S INITIAL] DATE CLOSED | OFFICER'S mt a OF AGH ACCOUNT NO. OPENED Scanned with CamScannerPie ACCOUNT NAME FIRST NAME maiooue NAME UWE HERESY AGREE TO BE GOVERNED EY THE RULES AND REGULATIONS GOVERNING THE ESTABLISHMENT AND OPERATION OF DEPOSIT ACCOUNTS ISSUED BY > ‘CORPORATION, BANGKO SENTRAL NG PIIPINAS AND THE BANKERS ASSOCIATION OF THE PHILIPPINES AS WELL AS ANY SUBSEQUENT AMENDMENT OR CHANGES THERETO WE ‘THAT THE INFORMATION SUPPLIED ON THE REVERSE SIDE OF THIS CARD IS TRUE AND CORRECT. PLEASE RECOGNIZE THE FOLLOWING SIGNATURES IN ALL TRANSACTIONS °5! SIGNATORY 2 INDIVIDUAL WITH ATA CORPORATION PARTNERSHIP PHOTO SINGLE PROPRIETORSHIP {2a} OTHERS PRODUCERS SAVING BANK CORPORATION will recognize(_ )ANYONE( =) ANYTWO() ALL of the following signatures in the payment of funds and other transactions on my/our account. 2 Signature wuereee| rn eee Scanned with CamScanneraoiseerse Bnor “hints to cet at the pew woe ne, ture Republic of the Philippines ESSIONAK| eauuntion commision ) reves aaa toes sat oan amare eatce er peek wth ali Biktcgesappemenen tne this to ce Tarher that elses poesona yt en, state oreo mcr cease redessorot Mpeenevsponca eet oF ee Scanned with CamScannerAccount Name iNoIiDUAL Account wor WBS ‘Ssanq Date of Risk Profiling O¢- Vw New BF Updating [] Fass ek mar. the box bene happiest te dept towns Reduced Ove oiigence oO Geant rare! by PSBC borrowers a) Obtain the oe in Custorne tte tenon ade) mang tog A nt status and with updategC/Bl reports © Deposivioan account of Bank employes dividual ten with es ZL Bclert resicing nthe Information Sheet and Agreement Form. lar employment of economically productive setvity ofthe branch with economically productive actaty Referred or marketed by the SBC employee Average Due Diligence [)sermsraeglrvrage tem is £3) Obtain the minimum information inthe Customer Account opened that wil be used for OFW remitances Information Sheet and Agreement Form 5) Obtaina ist of Banks where te indvcua has & Account tht was allowed tobe opened with BAU approval despite Imoinained oF s maintaining an account, failure to provide the complete required information 1 Pre-esising a €) Obtain alist of Companies where hes 3D i account in process to complete the minimum required information Offeer or stockholnar Aécount which led to update the required information every two 2} years) Banking Services tbe avaled of (se the back sheet forthe above information) Hah nist Enhanced Due Diligence 1 lent who was not properly/thoroughly identified a the point of acceptance 3) Obtain the minimum information © Ghent wns has potential to misuse or abuse his secount (eg. nom-prott 1.) Conti the date of birth from duly authenticated ‘organization (NPO) such as chats, foundations, cultural suscatons et oficaloeere cient suspected of orknown tobe engaringinreported/slegee very the permanent ads through evaluaton of _Unlawrul activity oF money laundering activity or offense as defined by low. uly ity bank or rested Sateen oe ney C Poticaty Exposed Person PEPs) or incvidals who are curry, or have een ‘been entrusted with prominent public function na pariulr court. <4) Comat te customer by phone, emailer etter (D Associate rend and family member of Pps. (anites rene peniaeoe Tien alscovered or known to have been refused of banking facies by €) Determine the authenticity of dentifcaton of ‘anather bank documents trough vaidation fits suance by 1D Account cpened by trustee, nominee or intermediary Fequesting a certification rom the issuing authority I Non-esten alien/acount fom countries dented 2: one ofthe ctr onpotiernea NNon-cooperative Countries and Territories (NCCT) by FATE Account whose franca profile charged G1 Niomesident account from countries identified a one othe Non: Cooperative Countries and Tetris (NCCT) by FATE o Previously reported STR account but business over decided tokeep the account open and for close monitoring LISTED IN DATA BASE: Place a check mark (V) on the applicable box/es Yes No orac a a Pep 'NGOs/Foundations oe Money Changer/FX Dealer/ Remittance Agent/Pawnshop oa romney ern a Scanned with CamScanner