CLASS B

LAND BANK OF THE PHILIPPINES New

Paniqui Branch Enrolment
Update Enrolment
Delete
weAccess ENROLLMENT AND MAINTENANCE AGREEMENT FORM

INSTITUTION PROFILE
Institution Name Short Name

Address ZIP Code Country

2307 PHILIPPINES
No. Street Barangay/District Municipality/City Province

Telephone Number Fax Number Tax Identification Number (TIN) Date of Incorporation
NA 01 15 2016
Area Code Telephone Number Ext. Area Code Telephone Number M M D D Y Y Y Y

BIR Registered Name Institution's Email Address1/ Corporate Type2/

LGU

SUBSIDIARIES
INSTRUCTIONS INSTITUTION NAME TAX IDENTIFICATION NUMBER (TIN)

- - -

THIRD PARTY ACCOUNTS

As Fund Transfer Destination
INSTRUCTIONS ACCOUNT TAG3/ ACCOUNT NUMBER
(please see attached list - Annex A) - -

- -
As Auto-Debiting Source
INSTRUCTIONS ACCOUNT TAG3/ ACCOUNT NUMBER

- -

BILLS PAYMENT
INSTRUCTIONS MERCHANT NAME REFERENCE NUMBER

STATEMENT OF ACCOUNT
Mode of Sending of SOA: SOA Formats for sending: Schedule of Sending SOA:
Email SFTP MT940 Multicash CSV Daily
SWIFT HTM SWIFT Format Monthly
SWIFT Address:

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

SK CHAIRPERSON SK TREASURER
Signature over Printed Name of Authorized Signatory Date

FOR BANK USE

SERVICING BRANCH/EO
Reviewed by Verified by Approved by

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) Please use additional sheets, if necessary.

1/
The designated email address where notices from the weAccess Facility shall be sent.
2/
e.g. GOCC, NGA, LGU, Private Corporation, Partnership, Cooperative, SME, Educational and Health Institution, Development Partnet, Religious and
Charitable Organization, Commercial/Universal Bank, Thrift Bank, Rural Bank, Other Financial Intermediary, NGO/People Organization/Association,
Micro-Enterprise, Sole Proprietorship
3/
The designated account description with a maximum of 15 alphanumeric characters (e.g. Payroll Account).
page 1
 CLASS B

ACCOUNT ACCESS PROFILE

INSTRUCTIONS ACCOUNT NUMBER ACCOUNT TAG1/

Add 0872 - - NAME OF SK

FUND TRANSFER BULK INTER-BANK FUND TRANSFER

Source Account Destination Account (via PESONet)
Authorization Rule Amount Range Authorization Rule Amount Range

BILLS PAYMENT LOAN PAYMENT

Authorization Rule Amount Range Authorization Rule Amount Range

AUTO CREDITING REQUEST AUTO DEBITING REQUEST

Authorization Rule Amount Range Authorization Rule Amount Range

CURRENT ACCOUNT SERVICES

ATM PAYROLL
(Checkbook Reorder)
Authorization Rule Amount Range Authorization Rule Amount Range

NAME OF AUTHORIZER 2000

ACIC FILE UPLOAD ACCOUNT TAG
Authorization Rule Amount Range Authorization Rule Amount Range

NAME OF AUTHORIZER NO LIMIT

FUND SWEEPING Mother Account Satellite Account

INWARD SWEEP OUTWARD SWEEP

(Group, Scheduled, Manual Inward Sweep Request) (Group, Manual Outward Sweep Request)
Authorization Rule Amount Range Authorization Rule Amount Range

REPORTS Downloadable Reports Viewable Reports

Salary Related Reports Adhoc Reports - Bills Payment Gov't. Merchant Reports
ePayments Reports Loan Profile Reports Others

INSTRUCTIONS ACCOUNT NUMBER ACCOUNT TAG1/

- -

FUND TRANSFER BULK INTER-BANK FUND TRANSFER

Source Account Destination Account (via PESONet)

Authorization Rule Amount Range Authorization Rule Amount Range

BILLS PAYMENT LOAN PAYMENT

Authorization Rule Amount Range Authorization Rule Amount Range

AUTO CREDITING REQUEST AUTO DEBITING REQUEST

Authorization Rule Amount Range Authorization Rule Amount Range

CURRENT ACCOUNT SERVICES

ATM PAYROLL
(Checkbook Reorder)
Authorization Rule Amount Range Authorization Rule Amount Range

ACIC FILE UPLOAD ACCOUNT TAG

Authorization Rule Amount Range Authorization Rule Amount Range

FUND SWEEPING Mother Account Satellite Account

INWARD SWEEP OUTWARD SWEEP

(Group, Scheduled, Manual Inward Sweep Request) (Group, Outward Sweep Request)
Authorization Rule Amount Range Authorization Rule Amount Range

REPORTS Downloadable Reports Viewable Reports

Salary Related Reports Adhoc Reports - Bills Payment Gov't. Merchant Reports
ePayments Reports Loan Profile Reports Others

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

SK CHAIRPERSON SK TREASURER
Signature over Printed Name of Authorized Signatory Date

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) Please use additional sheets, if necessary.
1/
The designated account description with a maximum of 15 alphanumeric characters.
page 2
 LAND BANK OF THE PHILIPPINES CLASS B
PANIQUI Branch Remarks: ___________________
(For Updating)
Name of Institution Short Name
BRGY ______ ________ ______ SK _______ SK
USER PROFILE
Name

First Name Middle Name Last Name

Address ZIP Code Country

2307 PHILIPPINES
No. Street Barangay/District Municipality/City Province
User ID Position/Designation Gender Date of Birth Date of Birth E-mail Address

BRGY TREASURER
M M D D Y Y Y Y
SOA Recipient via email? Contact Number/s Civil Status Tax Identification Number (TIN)
Yes No Landline Mobile
Single Divorced
NA
Challenge Questions Married Separated FOR BANK USE ONLY
1. Mother's Complete Maiden Name Widowed Internet Password Mailer ID
2. Name of High School - - -
3. Grandfather's Name
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
Add Authorizer Fund Transfer ACIC File Upload
✘ Report
Bills Payment Loan Payment
✘Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE 1/
ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information 2/
Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management 3/
More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

Signature over Printed Name of User Signature over Printed Name of Authorized Signatory Date

FOR BANK USE

SERVICING BRANCH/EO
Reviewed by Verified by Approved by

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) User ID must be composed of 6-8 alphanumeric characters, letters using upper cases only. The number zero should be written as "Ø"
 CLASS B

to differentiate from the letter "O".

1/
Authority of the designated user.
2/
All enrolled Users have Automatic access to Account Information, Customization, More Services, Administration and Help Desk Email.
3/
Fund Management includes Auto Crediting, Auto Debiting and Fund Sweeping Modules. page 2
 LAND BANK OF THE PHILIPPINES CLASS B
PANIQUI Branch Remarks: ___________________
(For Updating)
Name of Institution Short Name
BRGY ______ ________ ______ SK _______ SK
USER PROFILE
Name

First Name Middle Name Last Name

Address ZIP Code Country

2307 PHILIPPINES
No. Street Barangay/District Municipality/City Province
User ID Position/Designation Gender Date of Birth Date of Birth E-mail Address

M M D D Y Y Y Y
SOA Recipient via email? Contact Number/s Civil Status Tax Identification Number (TIN)
Yes No Landline Mobile
Single Divorced
NA
Challenge Questions Married Separated FOR BANK USE ONLY
1. Mother's Complete Maiden Name Widowed Internet Password Mailer ID
2. Name of High School - - -
3. Grandfather's Name
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
Add Maker Fund Transfer ✘ ACIC File Upload Report
Bills Payment Loan Payment
✘ Current Account Services

For Corporate Administrators only:

View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE 1/
ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management 3/
More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

Signature over Printed Name of User Signature over Printed Name of Authorized Signatory Date

FOR BANK USE

SERVICING BRANCH/EO
Reviewed by Verified by Approved by

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) User ID must be composed of 6-8 alphanumeric characters, letters using upper cases only. The number zero should be written as "Ø"
 CLASS B

to differentiate from the letter "O".

1/
Authority of the designated user.
2/
All enrolled Users have Automatic access to Account Information, Customization, More Services, Administration and Help Desk Email.
3/
Fund Management includes Auto Crediting, Auto Debiting and Fund Sweeping Modules. page 2
 LAND BANK OF THE PHILIPPINES CLASS B
PANIQUI Branch Remarks: ___________________
(For Updating)
Name of Institution Short Name
BRGY ______ ________ ______ SK _______ SK
USER PROFILE
Name

First Name Middle Name Last Name

Address ZIP Code Country

2307 PHILIPPINES
No. Street Barangay/District Municipality/City Province
User ID Position/Designation Gender Date of Birth Date of Birth E-mail Address

M M D D Y Y Y Y
SOA Recipient via email? Contact Number/s Civil Status Tax Identification Number (TIN)
Yes ✘ No Landline Mobile
Single Divorced
NA
Challenge Questions Married Separated FOR BANK USE ONLY
1. Mother's Complete Maiden Name Widowed Internet Password Mailer ID
2. Name of High School - - -
3. Grandfather's Name
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
Add Authorizer Fund Transfer ✘ ACIC File Upload Report
Bills Payment Loan Payment
✘ Current Account Services

For Corporate Administrators only:

View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management 3/
More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE 1/
ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management3/ More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information2/ Loan Profile Administration
ATM Payroll Customization EC NOW Access
Fund Management 3/
More Services Help Desk Email
- - Fund Transfer ACIC File Upload Report
Bills Payment Loan Payment
Current Account Services
For Corporate Administrators only:
View User (Add, Amend, Delete) Messages
Unlock User ID Administration
Reset Password Deposit Account Maintenance

ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.

Signature over Printed Name of User Signature over Printed Name of Authorized Signatory Date

FOR BANK USE

SERVICING BRANCH/EO
Reviewed by Verified by Approved by

Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) User ID must be composed of 6-8 alphanumeric characters, letters using upper cases only. The number zero should be written as "Ø"
 CLASS B

to differentiate from the letter "O".

1/
Authority of the designated user.
2/
All enrolled Users have Automatic access to Account Information, Customization, More Services, Administration and Help Desk Email.
3/
Fund Management includes Auto Crediting, Auto Debiting and Fund Sweeping Modules.
page 2