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The document appears to be a customer information sheet that collects personal details such as name, address, contact information, employment details, income information, bank account details, credit card information, and references for an applicant. It requests certification that the information provided is true and correct and authorizes the company to verify the details. The applicant and spouse are asked to sign and date confirming the accuracy of the information.

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Rodgen Valles
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144 views2 pages

Cis 1 2 1

The document appears to be a customer information sheet that collects personal details such as name, address, contact information, employment details, income information, bank account details, credit card information, and references for an applicant. It requests certification that the information provided is true and correct and authorizes the company to verify the details. The applicant and spouse are asked to sign and date confirming the accuracy of the information.

Uploaded by

Rodgen Valles
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 SHEET F-

SAL-002 | Rev 0 | 07/03/2017

CLIENT PERSONAL DATA


Last Name First Name Middle Name Citizenship

Attach here 1" x 1" ID Photo of


PRESENT HOME ADDRESS: (Unit /Room No. Building Name Lot/Block/Phase/House No. Street Name) Applicant

Subdivision Barangay Municipality/City Province ZIP Code Gender (M/F) Civil Status

PERMANENT HOME ADDRESS: (Unit /Room No. Building Name Lot/Block/Phase/House No. Street Name) Date of Birth Place of Birth:
(mm/dd/yy)

Subdivision Barangay Municipality/City Province ZIP Code Home No.:

Occupation: Mobile No.:


HOME OWNERSHIP
Employed
Owned Living w/ relatives/parents Years of Stay Email Add.:
Self-Employed
Mortgaged Rented at P________/mo.
Company
EMPLOYER/BUSINESS NAME (self-employed) Years in Employment Industry/Position EMPLOYER'S CONTACT
/Business DETAILS
(Area Code + Contact no.)
EMPLOYER ADDRESS: (Unit /Room No. Building Name Lot/Block/Phase/House No. Street Name) Landline

Subdivision Barangay Municipality/City Province ZIP Code Email Add.:

Preferred Mailing Address: MONTHLY INCOME TIN


Present Home Address Below Php 10,000.00 Php 30,000.00 - 50,000.00
Permanent Home Address Php 10,000.00-20,0000.00 Above Php 50,000.00
SSS/GSIS #
Employer/ Business Address Php 20,000.00- 30,000.00

SPOUSE /BENEFICIARY INFORMATION

Last Name First Name Middle Name Gender (M/F) Citizenship Home No.

EMPLOYER/BUSINESS NAME (if self-employed) Years in Employment / Date of Birth Place of Birth: Mobile No.
Business: (mm/dd/yy)

EMPLOYER ADDRESS: (Unit /Room No. Building Name Lot/Block/Phase/House No. Street Name) Occupation: Email Add
Employed

Subdivision Barangay Municipality/City Province ZIP Code Self-


employed

TIN: SSS/GSIS #:
No. Dependents/ Children Names (Last, First, Middle) Date of Birth Gender

BANK ACCOUNTS (Indicate your 3 most active)

Bank Branch/Address Type of Account Account No. Date Opened Average Balance

CREDIT CARDS OWNED (Indicate your 3 most active)

Issuer Name Card Type (Visa/Mastercard) Card Expiry (mm/yyyy) Credit Limit

CHARACTER REFERENCES

Name Address Telephone No.

Requirements:
CERTIFICATION
1 Proof of Billing

2 Proof of Income
I/We hereby certify that the foregoing information/statement is to my/our knowledge, true,
3 Two valid IDs (applicant) & One valid ID (spouse)
correct, complete and updated. The signature/s appearing below is/are genuine. I/we authorize
Myvan Properties and Development Inc. (MPDI) or its duly authorized representative to verify 4 Marriage Contract
necessary information or data. Should there be changes in information above, I/we will be 5 Community Tax Certificate
responsible to inform Myvan Properties and Development Inc. in writing of such changes. 6 Special Power of Attorney (if applicable)

Client's Signature over printed name Date Spouse Signature over printed name Date

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