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Epaycard Customer Account Opening Form

This document is an ePaycard customer account opening form. It requests information such as the customer's name, date of birth, address, citizenship, mobile number, email, SSS/GSIS/TIN numbers, employment details, and requires the customer's signature. The form is used to open an ePaycard account and collect know-your-customer information for regulatory compliance. Fields marked with a check are mandatory to fill out.

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Brian L
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86 views1 page

Epaycard Customer Account Opening Form

This document is an ePaycard customer account opening form. It requests information such as the customer's name, date of birth, address, citizenship, mobile number, email, SSS/GSIS/TIN numbers, employment details, and requires the customer's signature. The form is used to open an ePaycard account and collect know-your-customer information for regulatory compliance. Fields marked with a check are mandatory to fill out.

Uploaded by

Brian L
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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TMP-CH-90-20

EPAYCARD CUSTOMER ACCOUNT OPENING FORM


All fields with ✔(CHECK) are MANDATORY.
ACCOUNT DETAILS
DATE (MM/DD/YYYY) BRANCH CUSTOMER ID NO.

CLIENT TYPE TYPE OF ACCOUNT ACCOUNT NO.


New Client Existing Client Peso Dollar

CARDHOLDER DETAILS
TITLE / SALUTATION ✔NAME (Last Name, Given Name, Middle Name) ✔GENDER
✔ Male Female

✔ CIVIL STATUS MOTHER'S MAIDEN NAME (Last name, Given Name, Middle Name)
✔ Single Separated Widowed Married

✔ BIRTHDATE (MM/DD/YYYY) ✔ PLACE OF BIRTH ✔ CITIZENSHIP/ NATIONALITY


✔ Filipino Foreigner Dual Citizen

✔ MOBILE NO. ✔ EMAIL ADDRESS:

✔ PRESENT ADDRESS (No. / Street / District / Barangay / City / Town / Province) ✔ ZIP CODE

✔ PERMANENT ADDRESS ✔

✔SSS NO./ GSIS NO./ TIN ✔SOURCE OF FUNDS


Salary Business Commission/Fees Remittance Others

EMPLOYMENT DETAILS
COMPANY NAME / BUSINESS NAME (if Self-employed) ✔ INDUSTRY

BUSINESS ADDRESS (No. / Street / District / Barangay / City / Town / Province) ZIP CODE CONTACT NO. EMAIL ADDRESS

FATCA INFORMATION

CARDHOLDER'S SPECIMEN SIGNATURE


1) 2) 3)

CARDHOLDER ATTESTATION

CARDHOLDER AUTHORIZED HR REPRESENTATIVE


Signature over Printed Name / Date Signature over Printed Name / Date
FOR BANK'S USE ONLY (to be filled-out by the Sales Representative)
TYPE OF DEPOSIT CUSTOMER TYPE EMPLOYER ID RM/BM/AO CODE

REMARKS

IDENTIFIED & SIG. VERIFIED BY / DATE PROCESSED BY / DATE APPROVED BY / DATE APPROVED BY / DATE (FOR EDD)

Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Revised March 2020

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