CLASS D

CUSTOMER INFORMATION SHEET ✓ Exhibit 3

FOR INDIVIDUAL CUSTOMER

Customer ID No. (RM01) PHOTO

Type Code: (RM01) Personal Sub-type code: (RM01) X 10 - Individual 20 - Sole Proprietorship

PERSONAL INFORMATION
✓
First Name Middle Name Last Name

✓Current Address (RMCA) ✓Postal Code ✓Country ✓Length of stay

No. Street Subdivision Barangay/District Municipality/City Province

Philippines
✓Permanent
No.
Address (RMCA)
Street Subdivision Barangay/District Municipality/City Province
✓ Postal Code
✓Country ✓Length of stay
Philippines
Business Address (for Sole Proprietorship) (RMCA) Postal Code Country
No. Street Barangay/District Municipality/City Province

✓Tax Identification No. (TIN) (RMO1) ✓Residential Phone (Area Code+Tel. No.) (RM01) Business Phone (with local ext)(Area Code+Tel. No.) (RM01)

✓Mobile Phone (RMC1) Fax No. (Area Code + Tel. No.) (RMC1)
✓E-mail Address (RMCA)
✓Profession (RMC2) ✓Source of Funds (RMC2)
10 - Salary/Honoraria 30 - Business 50 - OFW Remittance 99 - Others, pls. specify
20 - Interest/Commission 40 - Pension 60 - Other Remittance
Date of Birth (mm/dd/yyyy) (RMC3)
✓PlaceMunicipality/City
of Birth ✓Nationality (RMC3) ✓Gender (RMC3)
✓ Province
Male Female

✓Civil Status (RMC3) ✓Mother's Maiden Name (First Name, Middle Name, Last Name) (RMC3)
Single Married Divorced SeParated Widowed

✓Valid ID's Presented (ID Type & No.) (RMC3) ✓Name of Spouse (First Name, Middle Name, Last Name) (RMC3)
✓1.
Valid ID's Presented (ID Type & No.) (RMC3)
✓2.
Valid ID's Presented (ID Type & No.) (RMC3)
FINANCIAL INFORMATION
✓ Employer Name (RMC4)
✓Job Title (RMC4)
✓No.
Employer Address (RMC4)
Street Barangay/District Municipality/City Province
✓Country
Occupation (RMC4) Monthly Gross Income (RMC4)
1 - Employed 3 - OFW 5 - N/A Under Php10,000 Php20,001 - 30,000 Php40,001 - 50,000
x 2 - Self-employed 4 - Retired Php10,001 - 20,000 Php30,001 - 40,000 Above Php50,000

✓Existing Accounts with LBP ✓Existing Accounts with other Banks

Bank/Branch Name Type of Account
SA/ATM Trust Trade
CA/ATM Loans Credit Card
TD Treasury

FOR SOLE PROPRIETORSHIP ONLY

Business Name (RMC5/RMCN)

Date Established (mm/dd/yyyy) (RMC5) Years in Business Total Employees (RMC5) No. of Permanent No. of Contractual
Employees Employees

Labor Union (Optional) (RMC5) No. of Member Employees

Nature of Work/Business/Economic Activity (SIC Code: RMC5)

0100 - Agriculture, hunting and forestry 0700 - Wholesale & retail trade 1300 - Public Administration & Defense
0200 - Fishing 0800 - Hotels & restaurants 1400 - Education
0300 - Mining & quarrying 0900 - Transportation 1500 - Health and Social Work
0400 - Manufacturing 1000 - Financial Intermediaries 1600 - Other Community, Social & Personal Services
0500 - Electricity, gas and water supply 1100 - Real Estate 1700 - Private Household with Employed Persons
0600 - Construction 1200 - Renting and business activities 1800 - Extra-Territorial Organizations & Bodies

I attest that the above information are true, correct and voluntarily given. The bank is authorized to give Left Thumbmark Right Thumbmark
information on the account to appropriate agencies in case of questionable transactions in relation to AMLA.

✓ ✓Date (mm/dd/yyyy)
Signature of Client
FOR BANK USE ONLY
Account Officer: (RMC1) Borrower since: (mm/dd/yyy)(RMC2)
Serviced by: Validated by: Encoded by:

Name/Designation Date Signature Date Signature Date

 DATA PRIVACY CONSENT FORM

I have read and understood the Land Bank of the Philippines (LANDBANK) Privacy Statement
and the Terms and Conditions for the products or services I applied for or availed of. I hereby
agree and consent that in applying and availing LANDBANK’s products and services, any or all
personal information, sensitive personal information or other confidential information that I
provided will be processed in accordance with the Data Privacy and Banking laws, rules and
regulations.

I likewise agree that LANDBANK may provide my personal information or sensitive personal
information and other confidential information, in the ordinary course of business, to the
following parties: (1) Any agent, contractor, subsidiaries or third-party service providers (e.g.
system providers, appraisers) which provide relevant services to LANDBANK; (2) Program or
tie-up partners, as applicable; (3) Credit bureaus or credit reference agencies, and in the event of
default, to debt collection agencies; and (4) Any regulatory, governmental tax, law enforcement,
or other agencies or authorities, clearing houses for purposes of complying applicable laws, rules
and regulations.

I am aware that under the Data Privacy Act, I have (a) the right to be informed; (b) the right to
reasonable access; (c) the right to object; (d) right to erasure or blocking of my/our personal
information, sensitive personal information or other confidential information; (e) right to
damages; (f) right to file a complaint; (g) right to rectification; and (h) right to data portability. I
understand that if I withdraw my consent, the Bank may not be able to provide certain products
and services to me.

_______________________________________________
Signature over Printed Name of Borrower/Depositor/Client

Date: ___________