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Jackilyn Murphy Lacsa: Bdofc

The document is an authorization form for recognizing specimen signatures of Jackilyn Murphy Lacsa in transactions with BDOFC. It includes a related party questionnaire to determine any affiliations with BDO and its affiliated companies. The form requires information on directorship, stock ownership, and family relations to BDO officials.

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16 views2 pages

Jackilyn Murphy Lacsa: Bdofc

The document is an authorization form for recognizing specimen signatures of Jackilyn Murphy Lacsa in transactions with BDOFC. It includes a related party questionnaire to determine any affiliations with BDO and its affiliated companies. The form requires information on directorship, stock ownership, and family relations to BDO officials.

Uploaded by

kq8xvjx2cz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BDOFC

JACKILYN MURPHY LACSA


____________________________________

We hereby fully authorize [you/ BDOFC] to recognize any of our


following specimen signatures in our transaction/s with BDOFC:
SPECIMEN OF FULL SIGNATURE

1. ___________________________________________

2. ___________________________________________

3. ___________________________________________
---------------------------------------------------------------------------

Bank use only


Date : Witnessed by: ___________________
Signature above printed name
RELATED PARTY QUESTIONNAIRE (Individual)
Name of the Client / Counterparty JACKILYN MURPHY LACSA
Date Accomplished

1. Are you a director, officer or stockholder of BDO and/or affiliated companies? [ ] Yes [ ] No

If YES, please specify the following:

Company Name: _______________________________ [ ] Director [ ] Officer [ ] Stockholder

Company Name: _______________________________ [ ] Director [ ] Officer [ ] Stockholder

Company Name: _______________________________ [ ] Director [ ] Officer [ ] Stockholder

For stockholders: Do you own shares of stocks of BDO and/or affiliated companies, collectively with your spouse and/or
relatives within the first degree of consanguinity or affinity, or relative by legal adoption? [ ] Yes [ ] No

If YES, please specify the following:

Name of Co-owner: _______________________________ Relationship: _______________________________

2. Are you a spouse or a first degree relative, i.e., parent or child (biological, legally [ ] Yes [ ] No
adopted, or in-law) of a Director, Officer, Stockholder of BDO and/or affiliated companies?

If YES, please specify the following: (Please attach additional sheets as necessary.)
Name of Relative Company Name

_______________________________________________________ ____________________________________
Last Name First Name Middle Name

_______________________________________________________ ____________________________________
Last Name First Name Middle Name

_______________________________________________________
Last Name First Name Middle Name _____________________________________

3. Are you a second degree relative, i.e., grandparent, brother, sister, grandchild [ ] Yes [ ] No
(biological, legally adopted, or in-law) of a Director, Officer, Stockholder of BDO and/or
affiliated companies?

If YES, please specify the following: (Please attach additional sheets as necessary.)
Name of Relative Company Name

_________________________________________________________ _____________________________________
Last Name First Name Middle Name

_________________________________________________________ _____________________________________
Last Name First Name Middle Name

_________________________________________________________ _____________________________________
Last Name First Name Middle Name

Accomplished by:

JACKILYN__________________________________________
MURPHY LACSA
Signature Over Printed Name

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