CUSTOMER INFORMATION SHEET

FOR PRIVATE INSTITUTIONAL CUSTOMER

CUSTOMER NO.: DATE CREATED/UPDATED (mm/dd/yyyy):

Type Code:

Sub-Type Code:

Commercial/Universal Bank Rural Bank Partnership/Corporation 82 - People’s Organization

40 - Expanded Commercial Bank 47 - Rural Bank 61 - Partnership 83 - Other Association
41 - Commercial Bank 48 - Cooperative (Rural) Bank 66 - Corporation 85 - (Barangay) Micro-Enterprise
Thrift Bank Other Financial Intermediary Cooperative 99 - Others
42 - Private Development Bank 51- Finance Company 71 - Multi-purpose
43 - Savings & Mortgage Bank 52 - Insurance Company 72 - Credit
44 - Stocks & Savings Loan Association 53 - Leasing Company NGO’s/People’s Organization/Association
45 - Microfinance Oriented Bank 54 - Investment House 81 - Non-Government Organization/Foundation
46 - Off-shore Banking Unit

INSTITUTIONAL INFORMATION
Registered Name of Institution
Pandacan Transport Service and Multi Purpose Cooperative
Tax Identification Number (TIN)
216 - 939 - 951 -
Principal Business Address (No./Street, Subd.,Brgy./Dist./Municipality/City,Province) ZIP Code
2944 Lorenzo Dela Paz St.Brgy 839 District VI Pandacan Manila 1011
Business Phone Number (Area code + Tel. no) (optional) Mobile Number E-mail Address
8-255-2850 ppandacantransport@yahoo.com
Date Registered (mm/dd/yyyy) Registration Place Registration Number

03/22/2010 9520-116011852
Registering Agency Years in Business Asset Size Number of Employees

Cooperative Development Authority 14 Medium 78

Is the institution an affiliate, subsidiary, or a branch? YES NO

If yes, what is the Parent Type? Philippine Corporation U.S. Corporation Other Foreign Corporation
OTHER INFORMATION
Nature of Business/Economic Activity
1700 - Private Household with Employed Persons G4547 - Wholesale and Retail Trade, Repair of Motor T9798 - Activities of Private Households as Employers and Undifferentiated
1800 - Extra-territorial Organizations and Bodies Vehicles and Motorcycles Goods and Services and Producing Activities of Households for own
1204 - Jewelry and Precious Stones Dealer H4953 - Transportation and Storage use (e.g., Activities of Households as Employers of Domestic Personnel
1005 - Foreign Exchange Dealer/Money Changer/ I5556 - Accommodation and Food Service Activities such as Maids, Cooks, Waiters, Valets, etc.)
Remittance Agent J5863 - Information and Communication U9900 - Activities of Extraterritorial Organizations, and Bodies (e.g., Activities of
A0103 - Agriculture, Forestry, and Fishing K6466 - Financial and Insurance Activities International Organizations, such as, United Nations, ASEAN, etc.)
B0509 - Mining and Quarrying L800 - Real Estate Activities V0000 - Others
C1033 - Manufacturing M6975 - Professional, Scientific, and Technical Activities V0001 - Others - Student/Minor/Retiree/Pensioner
D3500 - Electricity, Gas, Steam, and N7782 - Administrative and Support Service Activities V0002 - Others - Unemployed/Housewife
Air-conditioning Supply O8400 - Public Administrative and Defense; Compulsory 9200 - Gambling and Betting Activities
E3639 - Water Supply, Sewerage, Waste Social Security 9210 - OGOs and OGO Service
Providers
Management and Remediation Activities P8500 - Education 9220 - Casinos
(e.g., Cleaning Up of Oil Spills) Q8688 - Human Health and Social Work Activities
F4143 - Construction (e.g., Construction of R9093 - Arts, Entertainment, and Recreation
Buildings, Railroad Infrastructures) S9496 - Other Service Activities (Activities of Membership
Organizations)
Existing Accounts with LANDBANK Existing Accounts with Other Banks
Bank Branch Name Account Type
Savings Current Treasury None
Development Bank of the Philippines Savings Account
Time Deposit Trust Credit Card Security Bank Checking
Loans Trade With ATM Account

VALID DOCUMENTS PRESENTED

Document Name Document Name Document Name Document Name

Document Name Document Name Document Name Document Name

Document Name Document Name Document Name Document Name

Document Name Document Name Document Name Document Name

Document Name Document Name Document Name Document Name

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 I certify that the above information is true and correct. I hereby consent to the provisions of the Republic Act No. 10173 (Data Privacy Act of 2012).
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Signature over Printed Name

Validated by: Approved by:

Signature over Printed Name Date (mm/dd/yyyy) Signature over Printed Name Date (mm/dd/yyyy)
ACKNOWLEDGMENT SECTION

CTD CARD PASSBOOK CHECKBOOK

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Signature over Printed Name

FOR BANK USE ONLY

Approved by: Released by:

Signature over Printed Name Date (mm/dd/yyyy) Custodian Date (mm/dd/yyyy)

LIST OF STOCKHOLDERS OWNING AT LEAST 20%

Name of % of Source
No. TIN Birthday Address Citizenship Nationality Occupation
Stockholder owning Shareholding of Wealth
at least 20%

Conforme by:

Signature over Printed Name

FOR BANK USE ONLY
Validated by: Checked by:

Signature over Printed Name Signature over Printed Name

CIS -Private Institution | Page 2 of Revised August 2021
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 LIST OF STOCKHOLDERS OWNING A CORPORATE STOCKHOLDER

Name of % of Source
No. TIN Birthday Address Citizenship Nationality Occupation
Stockholder owning Shareholding of Wealth
at least 20%

Conforme by:

Signature over Printed Name

FOR BANK USE ONLY
Validated by: Checked by:

Signature over Printed Name Signature over Printed Name

LIST OF DIRECTORS AND SENIOR OFFICERS OF Pandacan Transport Service and Multi Purpose Cooperative

Contact Source
No. Name of Officer Position TIN Birthday Address Citizenship Nationality Occupation
Number of Wealth

Blk 16 Lot 10 PI Gideon St.

Edumundo B. Cadavona Chairman 264-429-541 07/24/1955 Married Filipino
North Olympus
Subd. Quezon City
Rico C. Lapid 1360 Rd 2 Alley 1 Bo. Obrero St. Filipino
Vice Chairman 10/14/1965 Married
214-043-380 Pandacan Manila

Wawa, Tanauan City

Victoriano C. Ortiz Board Member Married Filipino
750-058-038 03/06/1967 Batangas

Board Member 10/29/1962 2611 K. Jesus St. Pandacan

Bernardo R. Peran Jr. 459-181-674 Single Filipino
Manila

2841 Lorenzo Dela Paz Married

Edmundo R. Pastrana Board Member 767-859-508 02/28/1977 Filipino
St. Pandacan Manila

1368 Rd. 2 Alley 1

Marianto M. Pastrana Board Member 433-859-508 Married Filipino
07/16/1963 Obrero Pandacan Manila

2783 Beata St.

Nilo A. Pastrana Board Member 268-310-373 07/21/1969 Pandacan Manila Married Filipino

43-G Boston St. Brgy

Medel H. Afalla General Manager 111-671-790 04/19/1955 Immaculate Concepcion Filipino
Married
Cubao
2791 A Beata St. Filipino
Maja A. Paguio Board Secretary 165-157-156 07/22/19971 Married
Pandacan Manila

Block 7 Lot 65 Binga St. Single

Polyana C. Geronimo Treasurer 147-268-987 02/29/1972 Filipino
Napocor Village Tandang
Sora Quezon City

Conforme by:

Signature over Printed Name

FOR BANK USE ONLY

Validated by: Checked by:

Signature over Printed Name Signature over Printed Name

CIS -Private Institution | Page 3 of Revised August 2021
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 LIST OF AUTHORIZED SIGNATORIES OF Pandacan Transport Service and Multi Purpose Cooperative

Contact Source
No. Name of Officer Position TIN Birthday Address Citizenship Nationality Occupation
Number of Wealth

Edmund B. Cadavona Chariman 07/24/1955

Blk 16 Lot 10 PI Gideon St. Married Filipino
264-429-541 North Olympus
Subd. Quezon City
Victoriano C. Ortiz Wawa, Tanauan City Married
Board Member 750-058-038 03/06/1967 Filipino
Batangas

Nilo A. Pastrana Board Member 268-310-373 2783 Beata St. Filipino

07/29/1961
Pandacan Manila
Married

Conforme by:

Signature over Printed Name

FOR BANK USE ONLY

Validated by: Checked by:

Signature over Printed Name Signature over Printed Name

CIS -Private Institution | Page 4 of Revised August 2021

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 LAND BANK OF THE PHILIPPINES
DEPOSIT ACCOUNT TERMS AND
CONDITIONS GOVERNMENT &
INSTITUTIONAL CUSTOMERS

The following Terms and Conditions (T&C) shall govern my/our deposit
account/s with Land Bank of the Philippines 9. Pledge or Assignment of Account ADDITIONAL T&C FOR HIGH-YIELD SAVINGS ACCOUNT (HYSA)
The pledge or assignment of the Account or any amount therein shall
“LBP” and “Bank” shall refer to Land Bank of the Philippines. “I,” be subject to the prior consent of LBP. LBP reserves the right to I/We understood that this account is opened subject to the additional T&C
“We,” “me,” “us,” “my,” and “our” shall refer to the juridical entity or its impose conditions for its consent as may be reasonable under the herein contained and to the rules and regulations of the BSP, other
authorized representative/s to open or maintain deposit account/s with LBP. circumstances. government regulatory authorities and the BAP.
These T&C shall govern the use of passbook, checkbook and LBP’s 10. Lien on the Account 1. Minimum Amount of Deposit
Electronic Banking (e-Banking) facilities and services such as weAccess, LBP shall have a lien and authority to debit from my/our Account for the I/We agreed that the required minimum amount of deposit to open the
wePayAccess, etc. including any and all amendments thereto, and such other satisfaction of any obligation owed by me/us due to LBP, its subsidiaries and account shall be subject to the LBP’s existing policy. LBP reserves the right
rules, regulations, terms and conditions as may be issued by LBP from time affiliates (including but not limited to any applicable service charges, fees, and at any time and for any reason whatsoever to refuse to accept deposits
to time. penalties) without prior written notice. except in cash.
By signing on the T&C or my/our use of the passbook, checkbook and 11. Interest Rate I/We agreed that the deposits to the account may only be withdrawn in the
LBP’s e-Banking facilities and services, I/we hereby acknowledge and manner provided hereinafter. Further, I/we agreed that the Deposit Account
confirm that I/we have fully read, understood and agreed to be bound by Subject to applicable withholding taxes, the Account shall earn interest at shall not be used under nor covered by the automatic fund transfer
these T&C with respect to my/our deposit account or accounts such rate which LBP may compute based on its cleared balance on a arrangement.
(“Account” or “Accounts”). monthly or quarterly basis, at LBP’s option. LBP may, from time to time,
amend the applicable interest rate without prior notice. The Account shall 2. Interest
1. Account Opening not be entitled to interest where it is closed prior to an interest crediting The Account shall earn interest based on the prevailing rate for HYSAs at
I/We are duly authorized by our governing board or, in the case of date. the time of deposit, provided that in cases where the deposits are
government line agencies or bureaus, by the head of agency to enter into this withdrawn before due date, the interest shall be computed as follows:
12. Current Account
agreement with LBP. a. Fifteen (15) days and below from the date of the deposit, shall be
I/We accede to the electronic clearing of checks and hereby waive the equivalent to ¼ of the rate given on the date of deposit or the prevailing
I/We represent and warrant that I/we am/are the true and lawful owner/s of presentation for payment of the original to LBP. savings rate whichever is higher
the Account, and are authorized to sign such other agreements or b. More than fifteen (15) days from the date the deposit, shall be
documents related to the Account, subject to the submission of the Whenever the Account is mishandled as when the same is overdrawn or
whenever an amount is withdrawn in excess of the required minimum equivalent to ½ of the rate given on the date of deposit or the prevailing
documentary requirements of LBP. I/We agree to hold LBP free from savings rate whichever is higher.
any and all damages and liabilities that may arise from any fraudulent balance, I/we obligate to pay LBP the debit balance appearing, if any,
transaction in the account or fraudulent account opened in my/our name. in the Account and/or LBP’s applicable service charges. I/We further 3. Automatic Roll-Over
authorize LBP to close the Account when mishandled and to report the
fact of said closure and the reason therefor with the Banker’s Association A deposit not withdrawn on its due date shall be subjected to automatic roll-
The Account shall be governed by the present and future rules and over with the principal as the roll-over amount at the same term as the
regulations of LBP, the Philippine Clearing House Corporation (PCHC), the of the Philippines (BAP) or any central monitoring entity or body.
original deposit. Interest income on the original deposit shall only be
Anti-Money Laundering Council, the Bangko Sentral ng Pilipinas (BSP), included in the roll-over-amount subject to my/our prior written
and the applicable laws of the Philippines, as may be amended from time 13. Stop Payment Orders on Current Account
Stop payment orders may only be honored when filed under such form and authorization. Moreover, interest shall be the posted interest rate for
to time. HYSA at the time the automatic roll-over is effected.
manner as may be prescribed by LBP and before LBP’s certification,
I/We hold LBP free from any and all damages and liabilities in complying acceptance or payment of the check sought for stop payment. ADDITIONAL T&C FOR TIME DEPOSIT ACCOUNT
with the requirements of the law, including the reporting requirement to
authorized agencies. Notwithstanding the timely filing of the stop payment order, I/we agree to I/We understood that this account is opened subject to the additional T&C
hold LBP free and harmless from whatever liability that may arise when herein contained and to the rules and regulations of the BSP, other
2. Joint “AND” Account it honors the same. government regulatory authorities and the BAP.
My/Our rights and obligations under Account/s opened by two or more juridical
entities, through its authorized representative/s as in the case of joint I/We also agree that after the expiration of six (6) months from the date 1. I/We agree that this deposit shall earn interest based on the rate
ventures, shall be joint and not solidary. of stop payment of check, the request for stop payment shall be specified in my/our Time Deposit Certificate.
considered cancelled and should there be any fee occasioned by the stop
3. Deposits payment, the same shall be charged by LBP against my/our Account. 2. I/We must present the properly endorsed certificate upon applying for
The Bank may credit to my/our Account any cash and check deposit upon withdrawal of my/our deposit and surrender the same upon repayment of
14. Statement of Account the amount.
presentation of duly accomplished deposit slip and only after its proper
verification. Checks shall be accepted for deposit on collection basis and I/We acknowledge that a Statement of Account (SOA) shall be regularly
may be withdrawn only when cleared through the clearing house. sent to me/us via postal service at my/our last given address unless the 3. In case of pre-termination, I/we shall give a written notice to LBP
same is picked-up by my/our authorized representative from LBP seven (7) days prior to my/our withdrawal.
In receiving items for deposit, LBP’s obligation shall only be that of a Servicing Branch.
collecting agent and LBP assumes no responsibility beyond the 4. Unless presented on the date of maturity for withdrawal, LBP shall
necessary diligence in selecting correspondents. Until such time an The SOA shall be considered correct should LBP not receive any written dispose of my/our deposit in accordance with the Time Deposit Renewal
actual payment shall have come to its possession, LBP reserves the notice to the contrary within ten (10) calendar days after my/our receipt Instructions I/we signed upon placement.
right to charge back the Account for any amount previously credited. This thereof and any claim against LBP shall be considered waived.
5. Other T&C applicable to Time Deposit Account are incorporated in the
reservation shall also apply to checks drawn on LBP which are not paid 15. Updating of Account certificate.
because of insufficiency of funds, forgery, unauthorized overdraft, stoppage I/We shall promptly notify LBP in writing of any change in official
or any other reason. mailing/e-mail address, contact number/s or source of funds whenever ADDITIONAL T&C FOR LANDBANK e-BANKING
necessary, and shall personally fill out a new Specimen Signature Card as FACILITIES & SERVICES
Whenever improper or erroneous credit is made on the Account, LBP shall,
without prior notice and regardless of the intervening time that has elapsed be may be required by LBP. By maintaining my/our Account or Accounts with LBP, I/we am/ are
authorized to debit back any item previously credited. eligible to enroll my/our Account or Accounts with LANDBANK
16. Anti-Money Laundering e-Banking facilities and services such as weAccess, wePayAccess, etc., subject
4. Interbranch Deposit I/We warrant that the funds deposited are not proceeds of any criminal or to the laws, rules, regulations and official issuances applicable to the e-Banking
Interbranch deposit is allowed subject to LBP’s existing policy. illegal activity. The Bank reserves the right to close my/our Account Facilities, and any or all amendments thereof that may be issued in the future.
without prior notice or consent if there is reasonable ground to believe that
5. Passbook the funds are proceeds of a criminal or other illegal activity. All existing T&C of the deposit accounts not inconsistent with the provisions
Where the Account is Passbook-based, I/we agree that nothing shall be stipulated under the foregoing additional T&C shall remain in force and effect.
I/We hold LBP, its officers and employees free and harmless from
written therein which are not authorized by LBP. LBP shall not be whatever liability that may arise should I/we and/or the account be made
responsible for any sum recorded therein without LBP’s authorization. subject to the applicable provisions of the Anti-Money Laundering Law, as
In the event of any discrepancy between the entries in the Passbook and amended, such as but not limited to transaction reporting, investigation,
LBP’s records, the latter shall prevail. prosecution, asset preservation and/or forfeiture by applicable government
authority, as the case may be. I/We hereby read, understood and agreed to be governed by the
The Passbook is not assignable or transferable. The Bank shall have the foregoing T&C and the attached Deposit Account Information.
right to presume that the presenter of the Passbook is my/our duly authorized I/We hereby agree to hold LBP free and harmless from any and all
representative/s. I/We acknowledge that LBP possesses no obligation to damages and liabilities arising from technical errors committed by LBP in Where an Account is opened jointly with another, my/our rights and
indemnify me/us for unauthorized payments made on the Account prior to the processing of transactions except if the same is due to the gross obligations therein shall be joint and not solidary.
LBP’s receipt of notice of its loss. negligence of LBP or any of its employees.
Loss or destroyed passbooks may be replaced by LBP upon prior 17. Deposit Insurance
payment of applicable fees and compliance with its documentary
requirements. My/Our Account or Accounts shall be insured against such risks and to __________________________________________________________
such extent as may be prescribed under the applicable PDIC laws, rules _____
6. Withdrawals and regulations, and any and all amendments thereof that may be issued in
Withdrawals from the Account shall only be allowed by LBP upon the future. Signature Over Printed Name
presentation of a duly accomplished withdrawal slip and, where the 18. Closing of Account
Account is Passbook-based, the Passbook. ________________________________________________
I/We acknowledge that LBP has the right to close the Account at its sole
I/We agree that only checks/withdrawal slips containing signatures in ink discretion at any time if the Account is without any outstanding balance, turns _____
or other means in writing with a character of permanence which can be out to be fictitious, used for fraudulent purposes or for any reason that LBP
verified by LBP shall be honored. deems necessary to protect its interest. Date

7. Interbranch Withdrawal 19. Miscellaneous

Interbranch withdrawal is allowed subject to LBP’s existing policy. I/We attest that the information provided herein are true, correct and
voluntarily given. LBP is authorized to give information on the Account to
8. Dormant Account appropriate agencies in case of questionable implementation thereof, and
The Account shall be considered DORMANT when it becomes inactive (no represent and warrant that the opening of the Account and all
deposits or withdrawals) for a period of two (2) years for Savings transactions made thereon are not in violation thereof. I/
Account and one (1) year for Current Account. We acknowledge that LBP is duly bound to comply with certain __________________________________________________________
requirements under the law such as records management, reportorial
The Bank shall impose a monthly service charge on dormant account if the requirements, disclosure of certain information about the Account and _____
balance falls below the required minimum balance. transactions pertaining thereto, and in connection therewith, hereby holds Signature Over Printed Name
LBP free and harmless from any and all liabilities, claims and/or damages
The Account may further be reported to the Treasurer of the Philippines as an that may arise therefrom.
unclaimed balance under the Unclaimed Balances Law (Republic Act No. ________________________________________________
3936, as amended) where it becomes inactive for ten (10) consecutive I/We hereby authorize LBP, a banking institution duly organized and existing
_____
years. For the avoidance of doubt, accounts subject to rollover may be
considered inactive for purposes of the Unclaimed Balances Law even in
cases where a previous authority to have it automatically rolled over was
under and by virtue of the Provision of RA 3844, as amended, with
principal office at the LBP Plaza, 1598 M.H. del Pilar St. cor. Dr. - Date -
J. Quintos St. Malate, Metro Manila, Philippines to inquire and make
issued to LBP for as long as no deposits or withdrawals have been made at verification with any bank, financial or lending institution whether
my/our instance (other than through the previous authority issued to LBP to juridical or otherwise as to the state and condition of any and all kinds of Account Number:
Distribution: 1 - Branch’s copy 2 - Client’s copy
effect automatic rollover). accounts I/we keep and maintain with any or all of them, and I/we
hereby waive my/our rights to the secrecy thereof.
 DATA PRIVACY CONSENT FORM FOR DEPOSITORS

I/We authorize Land Bank of the Philippines, its subsidiaries, agents, representatives, and outsourced service providers
(“Bank”), to collect, process, update or disclose personal information about me/us in accordance with the Data Privacy Act,
its Implementing Rules and Regulations (IRR), Bank’s Data Privacy Statement, and bank secrecy laws, to verify, my/our
personal information from any person or entity that the Bank may deem necessary including, but not limited to, credit
bureaus, financial institutions, and government authorities, to establish, confirm, review or update my/our record, manage
my/our account and/or services provided to me/us, to conduct customer risk, capacity and suitability assessment, product
development and audit, to market its products and services, and other legitimate business purposes, and to comply with its
reporting obligations under applicable laws, rules and regulations.
I/We agree to hold the Bank and the persons or entities from whom it may obtain, or with whom it may disclose or verify
my/our personal information free and harmless from any liability arising from the use of any such information.
I/We confirm that I am aware that under the Data Privacy Act, I have (a) the right to withdraw the consent hereby given or to
object to the processing of my personal information provided there is no other legal ground or overriding legitimate interest
for the processing thereof; (b) right to reasonable access, (c) right to rectification, and (d) right to erasure or blocking of my
personal information subject, however, to the conditions for the legitimate exercise of the said rights under the Data Privacy
Act and its IRR, and subject further to the right of the Bank to terminate the product or service availed by me should I
withdraw my consent or request the removal of my personal information.

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