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PNB_Customer_Information_Form_Individual

The document is a Customer Information Form that collects personal, employment, and financial details from the applicant. It includes sections for identification, contact information, source of funds, and customer certification. The form also requires signatures for verification and approval by the bank.

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Jamaicah N. Naga
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21 views

PNB_Customer_Information_Form_Individual

The document is a Customer Information Form that collects personal, employment, and financial details from the applicant. It includes sections for identification, contact information, source of funds, and customer certification. The form also requires signatures for verification and approval by the bank.

Uploaded by

Jamaicah N. Naga
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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CUSTOMER INFORMATION FORM

1. PLEASE PRINT ALL INFORMATION


2. IF NOT APPLICABLE PLEASE INDICATE N/A.
Application Date: Preferred Domestic Branch: Facilitated by:

Full Name
Last Name First Name, Suffix Middle Name

ID Presented Date of Birth


ID Type ID Number Expiry Date (mm/dd/yyyy)

Present Address Contact Information


(Number/Street, Barangay/Subdivision, City/Municipality, Province/State, Country and Zip Code) Mobile Number

Landline Number

Permanent Address Same as above Present Address


Office Number
(Number/Street, Barangay/Subdivision, City/Municipality, Province/State, Country and Zip Code)

Email Address

Nationality Place of Birth

Employment Information Employed Self-Employed Student Retired


Employer Name / Business Name Nature of Work/Profession or Nature of Business/Position

Employer Address (Number/Street, Barangay/Subdivision, City/Municipality, Province/State, Country and Zip Code)

Source of Funds US FATCA

Salary Business Pension Property Yes, I am a U.S. Person (please fill-out the Consent & Authorization
for US Persons under US FATCA and W9 Forms)
Donation Commission Gaming Financial Products I am not a U.S. Person

Allotment Others (please specify __________________________________ ) I am not a U.S. Person but with U.S. Indicators
(please fill out the W8-BEN Form)

Civil Status

Remitter’s Name Relationship Currency Amount of Remittance Total Average Amount


Single Married Others
of Main Source of Fund

Y
Sex Citizenship

Male Female

Mother’s Maiden Name


Last Name First Name, Suffix Middle Name

Spouse’s Information
Full Name Date of Birth (mm/dd/yyyy) Occupation

Address (Number/Street, Barangay/Subdivision, City/Municipality, Province/State, Country and Zip Code) Same as above Present Address

CUSTOMER CERTIFICATION AND CONFIRMATION


By signing this form, I hereby:
1. Certify and affirm that the information given above and in related documents is true, accurate and complete. I authorize PNB to verify the truthfulness, accuracy and completeness of said information and agree to
promptly inform PNB in case of any change in said information; and
2. Acknowledge to have read, understood, agreed and received the Terms and Conditions Governing the Opening and Maintenance of Accounts, including those on Data Privacy, which was presented to me upon
opening of the Account and which can be accessed in PNB’s website www.pnb.com.ph as well as other terms and conditions governing deposit products, services and/or facilities that I availed or will avail in the future.

Signature Over Printed Name of Depositor

TO BE FILLED OUT BY THE BANK


Remarks Customer Contact: Customer ID Number Other IDs Presented:

Processed by: Signature Verified/Authenticated by: PSIC: AML/Client Info Category: Client Risk:

Signature Over Printed Name/Date Signature Over Printed Name/Date


Approved by: CIF Details validated Against System: Verified against CWS. OFAC, & Verified Against Residency Flag:
Original by:
Signature Over Printed Name/Date Signature Over Printed Name/Date Signature Over Printed Name/Date

Form No. NA001.4 (Rev. Nov.'24)

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