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Kyc Individual

This document collects Know Your Customer (KYC) information and identification documents from Celeste A. Bawag to comply with anti-money laundering requirements. It gathers her personal details like name, date of birth, address, nationality, source of funds, and occupation. It also asks if she has any relationship with government officials. Ms. Bawag consents to sharing this information and to receiving marketing communications. She will provide a photo ID to verify her identity.

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Celeste Bawag
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216 views1 page

Kyc Individual

This document collects Know Your Customer (KYC) information and identification documents from Celeste A. Bawag to comply with anti-money laundering requirements. It gathers her personal details like name, date of birth, address, nationality, source of funds, and occupation. It also asks if she has any relationship with government officials. Ms. Bawag consents to sharing this information and to receiving marketing communications. She will provide a photo ID to verify her identity.

Uploaded by

Celeste Bawag
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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KNOW YOUR CUSTOMER - INDIVIDUAL CLIENT

✔ I am allowing Pioneer Insurance & Surety Corporation to collect and use my Know Your Customer (KYC) information and identification documents
from its related insurance companies for purposes of complying with the customer due diligence requirements under the Anti-Money Laundering
Act of 2001.
To better serve you, please share with us some of your personal information.
Given Name Middle Name Last Name Generation Name (e.g. Sr., Jr., III)
Full Name
of Customer: CELESTE ATIENZA BAWAG
MM DD YYYY
Date of Birth: 04 06 1981 BIR TIN: 244718824

Sex: Male Female Civil Status: Single ✔ Married Others

Mobile Nos.: Email Address: Landline Nos.:


09274175356 celbawag@yahoo.com N/A
No. Street Building Barangay
Present Address:
137 A. Mabini St. 5
City/Town/Province Country Zip Code

Amadeo, Cavite Philippines 4119


No. Street Building Barangay
Permanent Address:
(if different from Present
Address)
City/Town/Province Country Zip Code

To signify our joint support for the Anti-Money Laundering Act of 2001 (AMLA), please provide us with the following
additional information:
Place of Birth: Silang, Cavite Nationality: Filipino

Please submit a clear copy of any one of the following photo- and signature-bearing ID to your agent or Pioneer account officer or email to
cim.digicur@pioneer.com.ph: Driver’s License Passport Postal ID Senior Card OWWA ID PRC Voter’s Card
GSIS No. ✔ SSS PhilHealth  Others
Source of Funds: Employee Businessman/Entrepreneur Self-Employed Professional Government Employee Others

Nature of Work/Business: Education Name of Employer/ Business: DepEd

Politically-Exposed Persons (PEP) Questions:


1. Are you a present or a former Government Official? Yes ✔ No
2. Do you have a close or family relationship with any Government Official/s? Yes ✔ No
If Yes, please specify: Relationship:
Note: If answer to the above is “Yes” please answer a separate PEP Questionnaire.
By affixing my signature below, I hereby consent to be bound by obligations set out in the relevant United Nations Security Council Resolutions
relating to the prevention and suppression of proliferation financing of weapons of mass destruction.
In compliance with the Data Privacy Act of 2012, please give us your consent below.
DATA PRIVACY CONSENT
I agree and consent that to the extent required by law, Pioneer, may collect, use, and process my personal information contained in my insurance
application form for any of the following purposes, in accordance with the Data Privacy Act of 2012 and Pioneer’s Data Privacy Policy:
a. to process my application;
b. to administer my policy/ies;
c. to provide customer service and support;
d. to research and conduct data analytics to improve customer service;
e. to inform me of latest updates, special offers, and event invites related to my policy/ies;
f. to comply with the legal and statutory requirements and processes imposed by the courts and different regulatory bodies such as the Insurance
Commission and the Anti-Money Laundering Council.
I am aware and have read Pioneer’s Data Privacy Notice, which contains my rights as a data subject, including the right to access and correction,
and the right to object, may be viewed via www.pioneer.com.ph/about-us/data-privacy-notice.
✔ Yes, I would also like to get special offers, event invitations, marketing promotion and updates from Pioneer Insurance & Surety Corporation
sister companies and partners (list of member companies and partners is shown on www.pioneer.com.ph/about-us ). I understand that this
requires sharing of my personal contact information with the sister companies and partners with the assurance that my personal contact
details are handled with the utmost care and confidentiality.
I hereby certify that I have carefully read, clearly understood and agreed on the above.
Name and Specimen Signature: Date and Place:
CELESTE A. BAWAG April 27, 2023 / Amadeo, Cavite
Note: The security of your personal information is our priority. We protect this information by maintaining physical, technical and organizational measures
and by following practices on data security.
If you have any questions or concerns about your information and/or how we process your personal data, you may contact us through email at
dpo@pioneer.com.ph or call us at (02) 8812-7777 from 8 am to 6 pm, Monday to Friday.

PIONEER INSURANCE & SURETY CORPORATION


Pioneer House Makati, 108 Paseo de Roxas, Legazpi Village, Makati City 1229, Philippines
Tel: +63 2 8812 7777 or +63 2 7750 9999 • Fax: +63 2 8817 1461 • www.pioneer.com.ph
revised as of 02/22/2021

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