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Customer Information Form Individual

I. CUSTOMER INFORMATION
Name

First Name and Suffix (Jr., III) Middle Name Last Name
Mother’s Maiden Name (First Name, Middle Name, Last Date of Birth (mm/dd/yyyy) Place of Birth
Name)

City/Municipality Province Country

Sex Country of Nationality Type of ID Tax Identification Number (optional)
Male Female
Mobile Number Email Address Landline Number (optional)
(_________) - __________-___________
Area Code Landline Number
Address (this will serve as the default mailing address)

House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code

II. CLIENT PROFILE

Spouse’s Name

First Name and Suffix (Jr., III) Middle Name Last Name
Civil Status Purpose of Account Opening
Unmarried Widowed Divorced/ Annulled Personal (includes savings, investment, personal remittances [e.g., pension, payroll, allowance])
Married Separated Small Business
Delivery of Monthly Bank statement With Beneficial Owner?
Electronic ( Mail Yes (fill-out Section III of the form) None
Do you hold a prominent public position in the Philippines/ a Foreign State/ an Does any of the following in your family hold a prominent public position in the
International Organization? Philippines or any foreign state, OR a position in any International Organization?
Yes No Spouse/Partner
Do you maintain a particularly close relationship with a person who holds a Child (biological/adoptive/by law)
prominent public position in the Philippines/ a Foreign State/ an International Parent (biological/adoptive/by law)
Organization? Grandparent (biological/adoptive/by law)
Grandchild (biological/adoptive/by law)
Yes No Sibling (biological/adoptive/by law)
Do you conduct substantial domestic and international financial transactions on
behalf of a person who holds a prominent public position in the Philippines or any
foreign state, OR a position in any International Organization? Name:

Yes No Position:
Country of Residence US TIN US Social Security Number US Telephone Number

US Address

House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code
Types of Products and Services to be availed from the Bank
Current/Checking and Savings Account Treasury Trust Remittance – Country/ies of Destination:
Prepaid Card/Paycard/and Cashier/Gift Check Time Deposit Personal Management Trade Service/Facility - Country of
Payroll Personal Loans Asset Management/UITF Residence/Operations of the Counterparty/
Private Banking Credit Card Escrow/Fiduciary Services Intermediary:
Safety Deposit Box Cash Management
Expected Frequency of Transactions per Month Average amount per Transaction
Five times (5x) or less Ten times (10x) > fifteen times (15x) Below ₱ 50,000 ₱ 500,001 and above, please indicate amount:
Six times (6x) > ten times (10x) More than fifteen times (15x) ₱ 50,000 to ₱ 100,000
₱ 100,001 to ₱ 500,000
Modes of Depositing Funds Job Title/Position
Cash Deposit Check Manager’s Check Online Banking Top/Senior Management
Remittance: Manager/Middle Management
 If cross-border, Country of Origin: Rank and File/Clerical
 If domestic, City of Origin: Overseas Filipino Worker
 Relationship with Remitter: Professional/Consultant
 Spouse/Partner  Parent/Parent-in-Law Government Employee
 Biological/Adopted Child  Relative Student
 Son-in-Law/Daughter-in-Law  Others: Self-Employed
Retired/Unemployed
Source/s of Wealth (please check ALL that apply)
Salary, please choose code from industry list: Pension
Commission, please choose code from industry list: Sale of Asset
Business, please choose code from industry list: Winnings
Remittances, please specify country of origin: Interest Income
Allowance – Nature of employment/business of the Benefactor, please choose code from the industry list: (interest through
Donation/Inheritance, please specify the following: investment/lease of
 Name of Benefactor/Donor: property, et al.)
 Relationship with Benefactor/Donor:
III. BENEFICIAL OWNER INFORMATION
Name

First Name and Suffix (Jr., III) Middle Name Last Name
Date of Birth (mm/dd/yyyy) Place of Birth Nationality

City/Municipality Province Country

Address

House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code
Mobile Number Email Address
Source/s of Wealth (please check ALL that apply)
Salary, please choose code from industry list: Pension
 Commission, please choose code from industry list: Sale of Asset
Business, please choose code from industry list: Winnings
Remittances, please specify country of origin: Interest Income
Allowance – Nature of employment/business of the Benefactor, please choose code from the industry list: (interest through
Donation/Inheritance, please specify the following: investment/lease of
 Name of Benefactor/Donor: property, et al.)
 Relationship with Benefactor/Donor:
Do you hold a prominent public position in the Philippines/ a Foreign State/ an Does any of the following in your family hold a prominent public position in the
International Organization? Philippines or any foreign state, OR a position in any International Organization?
Yes No Spouse/Partner
Do you maintain a particularly close relationship with a person who holds a prominent Child (biological/adoptive/by law)
public position in the Philippines/ a Foreign State/ an International Organization? Parent (biological/adoptive/by law)
Yes No Grandparent (biological/adoptive/by law)
Do you conduct substantial domestic and international financial transactions on Grandchild (biological/adoptive/by law)
behalf of a person who holds a prominent public position in the Philippines or any Sibling (biological/adoptive/by law)
foreign state, OR a position in any International Organization? Name:
Yes No Position:
IV. AGENTS/AUTHORIZED REPRESENTATIVES (only if applicable)
Name (First Name, Middle Name, Last Name) Contact Number Nationality

Address

House/Unit Number Floor Building Name Street Subdivision Barangay Municipality/City Province Country ZIP Code
V. CONFORMITY
By signing below, I confirm that I received and read the terms and conditions governing the various products and services I availed from the Bank as specified above. I have
fully understood and agree to be governed by the provisions thereof. I fully understand and accept the corresponding risks involved in availing of such banking products, facilities,
or services and understand further that my continued use and/or availment of these banking products, facilities, or services shall mean my conformity to any and all
supplement(s), modification(s) or amendment(s) of their corresponding terms and conditions which may be posted in conspicuous places within the Bank's premises or which
may be published by the Bank in any other manner.
I also warrant that I am aware of the provisions of Republic Act No. 9160 (Anti-Money Laundering Act of 2001) as amended, and I represent that my transactions herein are
not among those covered under said law and that my funds come from my legitimate undertakings. I authorize the Bank to make any such verification or reports in compliance
with RA No. 9160, as amended, as it may deem appropriate, for which acts I hold the Bank free and harmless from any and all liabilities, claims and/or damages.
In case I apply for any credit accommodation, I hereby authorize the Bank and its officers and staff to obtain from and/or to disclose to other parties (including other banks)
information on my deposits and other properties with Metrobank or with other banks.
In compliance with the BSP Manual of Regulations for Banks, I also agree and consent that my account may be selected in the regular generation of Confirmation Letters by
Metrobank’s Audit Group to confirm account balances. The Confirmation Letter will be sent directly to my address provided above.

Customer’s Signature over Printed Name Date

VI. DATA PRIVACY CONSENT

BY SIGNING THIS FORM BELOW, I hereby allow Metrobank: (1) share my personal data with subsidiaries and affiliates within the Metrobank Group and/or any agent or third
party that provides services or has contractual obligations with the said group; (2) collect additional information directly or indirectly, including but not limited to my financial
capabilities and business results, trade dealings with customer/suppliers and other financial institutions, business relationship with individuals and/or entities that the Bank may
identify and other necessary information to facilitate the processing of any application for/availment of a credit facility; and (3) disclose my personal data to any administrative,
legislative, judicial, quasi-judicial, and law enforcement offices of the government for legitimate purposes under the law other than those already required by regulations.

I am doing this:
 So that Metrobank can fully assess all information necessary to facilitate my loan application, if availed,
 So that Metrobank, its subsidiaries, and its affiliates, can further secure me from fraud, unauthorized and illegal transactions, and anti-money laundering and terrorist
financing risks,
 So that my data can be used in the settlement of disputes or claims regarding my account(s) through prosecution or the defense of Metrobank or its staff,
 So that my relevant data can be validated, verified, and updated if needed,
 So that I can be offered products and services within the Metrobank Group that are relevant and suitable to me based on my data, and
 So that Metrobank can better perform its obligations to the law, rules and regulations, contracts, or orders from any courts or quasi-judicial and administrative offices.

I recognize that processing of my personal data for the above purposes shall be in accordance with Metrobank’s Privacy Policy found on its website metrobank.com.ph, and I
acknowledge that I have read the same.

If I want to access, update, or correct my personal data, or withdraw my consent to use my data as stated in this form, I have the following options:
 Send a letter to my branch of account,
 Email dataprotectiondept@metrobank.com.ph, or
 Use any of our available e-channels, website or app, if available

If I withdraw my consent to use my data, or if I settle and close my engagements with Metrobank, I am aware that Metrobank has five (5) years to delete and securely
dispose of my data.

Customer’s Signature over Printed Name Date

TO BE FILLED-OUT BY THE BANK

Branch Code Branch Name RM / Customer Number

New Customer Existing Customer Customer at Branch Outside of Branch

DECLARATION AND ACKNOWLEDGEMENT:
I declare that the face-to-face conduct of KYC as Reviewed Account Opening Documents and Signature Approved by (for High Risk)
prescribed by BSP has been performed. Authenticated/Approved by

Signature over Printed Name of Bank Officer Signature over Printed Name of Bank Officer Signature over Printed Name of Bank Officer

MB-I-M-217.1/Rev. Jan. '25