CUSTOMER INFORMATION FORM (Individual)

1 CUSTCUSTCUSTCUSTCUSTOMER INFORMAOMER INFORMAOMER INFORMAOMER INFORMAOMER INFORMATION FORM TION FORM TION FORM TION FORM TION FORM (Individual)PERSONAL INFORMATIONNOTES:1. PLEASE PRINT ALL IF NOT APPLICABLE PLEASE INDICATE ALL FIELDS WITH ASTERISK (*) ARE PLEASE INFORM THE BANK IMMEDIATELY FOR ANY (MM/DD/YYYY)_____LAST NAME*TAX IDENTIFICATION NUMBER*Attach recent1x1 Photo_____BRANCHFIRST NAME*MIDDLE NAME*DATE OF BIRTH (MM/DD/YYYY)*PLACE OF BIRTHCIVIL STATUS*SingleMarriedDivorcedSeparatedWid owedEDUCATIONAL ATTAINMENT:Doctorate DegreeMaster s DegreeAssociate DegreeHigh School GraduateOthers (Pls. Specify)_____College DegreeNATIONALITY*GENDER*MALEFEMALEYOUR MOTHER S FULL MAIDEN NAME: (Last Name, First Name, Middle Name)FilipinoOthers(pls. Specify)_____ACR NO.

2 , If AlienCOUNTRY OF ORIGINOTHER IDs PRESENTEDGSIS _____SSS _____Driver s License _____Passport _____Others (Pls. Specify)_____ CONTACT INFORMATION1. Present Address*NumberStreetSubdivision/Village/ BarangayCity / StateCountryZipCodeYears ofResidenceArea CodeTelephone NumberMobileNumber*_____Email Address*_____Other Social Media Account ( Facebook, Twitter etc.)2. Permanent Address*NumberStreetSubdivision/Village/ BarangayCity / StateCountryZipCodeYears ofResidenceArea CodeTelephone NumberEMPLOYMENT INFORMATIONEMPLOYER NAME:*NATURE OF WORK / PROFESSION:*EMPLOYER / BUSINESS ADDRESS:NumberStreetSubdivision/Village/ BarangayCity / StateZipCodeArea CodeTelephone NumberEMPLOYMENT STATUS:EmployedRetiredSelf-EmployedUnemp loyedStudentOthers (Pls. Specify)_____BUSINESS NAME (If Self-employed):*NATURE OF BUSINESS / POSITION (If applicable):* CUSTOMER NAME:_____ CUSTOMER ID NUMBER: _____FOR BANK USE ONLY Form NA001_____ CUSTOMER ID PERSONS UNDER FOREIGN ACCOUNT T AX COMPLIANCE ACTAre you a Person?

3 Permanent Address (Floor, Number, Street, City, State, Postal Code)_____ SIGNATURE OF ACCOUNTHOLDER / DATEIf Yes, please fill-out the INFORMATION Foreign Account Tax Compliance Act ( FATCA ) enacted by the government in March 2010 and which amended the Internal Revenue Code, is part of the efforts to improve tax compliance of taxpayers with foreign financial assets and offshore further INFORMATION on FATCA, you may visit the following websites: ; ; / POSITION:EMPLOYER / BUSINESS ADDRESS:A person is one who is: An individual or an Entity One who has substantial presence in the A citizen As evidence by Indicia of account ( Citizen, place of birth, Holds a Tel no. Standing instruction to pay amounts to an authority maintained A resident of the the , Current power of attorney or signatory granted to a person with a Was born in the address, a in care of or an hold mail address that is sole address A Permanent Resident Card Holderidentified for the account).

4 _____ PRINTED NAME OF ACCOUNTHOLDERFOR BANK USE ONLYCUSTOMER CONTACT:Walk-inSolicitedReferredACCOUNT SOLICITED BY:_____Signature Over Printed Name / Employee ID No. / DateNAME OF REFERROR:RELATIONSHIP:ADDRESS OF REFERROR:SIGNATURE AUTHENTICATED BY:ACCOUNT OPENINGPROCESSED BY:ACCOUNT OPENING APPROVED BY:_____ SIGNATURE OVER PRINTED NAME / DATE_____ SIGNATURE OVER PRINTED NAME / DATE_____ SIGNATURE OVER PRINTED NAME / DATEIDs PRESENTED:VERIFIED AGAINST CWS:_____ SIGNATURE OVER PRINTED NAME / DATEVERIFIED AGAINST OFAC / INF:_____ SIGNATURE OVER PRINTED NAME / DATEDOCUMENTS VERIFIED AGAINST ORIGINALS BY:_____ SIGNATURE OVER PRINTED NAME / DATECUSTOMER S AGREEMENTFOR BANK USE ONLY_____ SIGNATURE OVER PRINTED NAME / DATEN umberStreetSubdivision/Village/BarangayC ity / StateZipCodeArea CodeTelephone NumberBy signing this form, the ACCOUNTHOLDER hereby certifies and affirms that the INFORMATION given above is true, correct and updated.

5 The ACCOUNTHOLDER hereby allowsPNB to verify said INFORMATION and agrees to inform PNB of any change in the INFORMATION provided ACCOUNTHOLDER hereby acknowledges to have read, understood and agreed to the terms and conditions governing the deposit products, services and facilities of PNBwhich the ACCOUNTHOLDER has availed of or shall, in the future, avail from PNB. The ACCOUNTHOLDER agrees to be bound by the terms and conditions thereof as well asto such relevant laws, rules and regulations governing the said deposit products, services and facilities. The said terms and conditions, including the applicable service andmaintenance fees, were provided to the ACCOUNTHOLDER and are available via purposes of compliance with relevant laws and regulations issued by appropriate regulatory authorities and agencies of the Philippines and such other countries havingjurisdiction over the ACCOUNTHOLDER, the ACCOUNTHOLDER hereby authorizes PNB, its branches and agencies, and all of PNB s subsidiaries, affiliates or correspondentbanks to access all INFORMATION relating to the ACCOUNTHOLDER s PNB deposit account/s, (where applicable)

6 Disclose the ACCOUNTHOLDER s financial accounts to the USlnternal Revenue Services as required for participating financial institutions under the US Foreign Account Tax Compliance Act (FATCA) due diligence rule, and disclose such dataand papers pertaining to the ACCOUNTHOLDER s deposit accounts as may be required by government regulatory authorities, here and abroad, conformably with INFORMATIONDATE OF BIRTH (MM/DD/YYYY)LAST NAME*FIRST NAME*MIDDLE NAME*ADDRESSCOMPANY NAME:NumberStreetSubdivision/Village/Bar angayCity / StateZipCodeArea CodeTelephone Social Security Number:Document Presented:W-8 BEN FormW-9 FormThe accountholder (individually the ACCOUNTHOLDER and collectively, the ACCOUNTHOLDERS ) hereby stipulates and agrees to be governed and boundby the following terms and conditions governing the opening and maintenance ofthe deposit account (the Deposit Account ).

7 Further, the ACCOUNTHOLDER hereby stipulates and agrees to be bound bypertinent laws, rules and regulations of the Bangko Sentral ng Pilipinas (BSP),Bankers Association of the Philippines (BAP), as well as any subsequentamendments or supplements thereof and any new laws or rules to be promulgatedwhich are applicable to the Deposit Deposit Accounts shall be additionally governed by the terms and conditionsspecific to such accounts as contained in the supplementary agreements attachedhereto (the Supplements ) and, where applicable, the terms and conditions providedin the passbooks evidencing the Deposit Deposits shall be credited to the Deposit Account afterverification and count by the BANK.

8 The amount verified shall be deemed to be thecorrect amount deposited by the ACCOUNTHOLDER. Any discrepancies noted shallbe communicated to the consideration of the BANK s acceptance of deposits which are not counted in theACCOUNTHOLDER s presence by way of special accommodation, theACCOUNTHOLDER hereby assumes the sole responsibility for any shortages/overageswhich may be found when the deposit is counted and the total thereof checkedagainst the amounts indicated on the deposit slip/s and holds the BANK free andharmless from any liability arising therefrom. However, should any shortages oroverages be found, the BANK shall advise the ACCOUNTHOLDER of such BANK is hereby authorized to correct the entries in the deposit slip/s presentedto reconcile with the actual deposit received as verified by the BANK s DEPOSITS.

9 The BANK reserves the right to reject any checkdeposits, including but not limited to second/multiple-endorsed checks, treasurywarrants and postal money check/ draft/ negotiable instrument received by the BANK for deposit orcollection is subject to actual receipt in cash of the proceeds thereof. In receivingcheck deposits, the BANK obligates itself only as the ACCOUNTHOLDER s collectingagent and assumes no responsibility beyond the exercise of due such time when the deposit item is cleared and the funds are transferred to andin the BANK s possession, withdrawal against these uncollected funds shall not beallowed by the BANK. Furthermore, until such receipt, the deposit item shall be heldat the risk of the ACCOUNTHOLDER and the BANK assumes no responsibility beyondthe exercise of due care.

10 The BANK will not be liable for default or negligence of itsduly selected correspondents nor for losses in transit and no correspondent so selectedshall be liable except for its BANK reserves the right to charge back any defective or lost item previouslycredited to the Deposit Account regardless of the time that has elapsed and regardlessof whether or not the deposit item itself can be returned or to reverse/correct entriesthat were erroneously credited to the Deposit Account due to mistake or technicalerrors without need of any notice. The ACCOUNTHOLDER assumes full responsibilityfor the validity of the deposit item as well as the correctness and genuineness ofendorsement/s OR THEFT OF DEPOSIT ITEM. The BANK shall not be responsiblefor any payment it may make on any deposit item prior to its notice of loss/ theft ofdeposit item and such payment shall have the same effects as if made to theACCOUNTHOLDER personally except in case of patently discernable acts of forgeryor PAYMENT.