DEVELOPMENT BANK OF THE PHILIPPINES
BB 0716.r2.2021
Customer Information File Form
Corporate
Name of Entity*
CLIENT INFORMATION
Trade/Business Name Short Name
Form of Organization*
☐ Single/ Sole Proprietorship
Indicate owner name:
Last Name, First Name, Suffix (e.g. Jr. Sr.) Middle Name
☐ Partnership ☐ Association
☐ Corporation ☐ Foundation
☐ Cooperative ☐ Non-Government Organization (NGO)
☐ Government Unit/Entity
Sector*
☐ Private ☐ Government
Sub-Sector*
☐ Financial ☐ Local Government Unit
☐ Non-Financial ☐ Government Owned and Controlled Corporation
☐ Bank ☐ State University/College
☐ National Government
Type of Registration*
☐ Securities & Exchange Commission ☐ Cooperative Development Authority ☐ Others ___________________
☐ Department of Trade & Industry ☐ Republic Act
Nature of Business*
☐ Banking ☐ Financial Services ☐ Services ☐ Wholesale/Retail Trade
☐ Education ☐ Government ☐ Transport & Storage ☐ Others ___________________
Taxpayers Identification Number*
Registration /Creation Number*
Date of Registration*
-
-
MM DD YYYY
Current Legal Status*
☐ Active
☐ Bankruptcy
☐ Under Conservatorship
☐ Under Custodianship
☐ Under Liquidation
☐ Under Receivership
☐ Under Rehabilitation
Place of Registration*
Beneficial Owner/s* Indicate complete name/s (attach separate sheet as needed) and
refer to Beneficial Owner form
Residency* Indicate full name of country of residency if non-resident
☐ Resident ☐ Non-Resident ___________________
Office/Business Address*
Unit/Floor/Bldg No. Block No./Lot No./Phase No./Bldg. Name Street Name Subdivision/Village/Purok/Sitio/Barrio
Barangay Town/Municipality/City/District/State Province/Region Country Zip Code
Office Telephone Number*
Country Code-Area Code-Identifier-Phone No/Local
Mobile Number* Email Address*
Country Code-Provider Code-Phone No.
Plant Address* ☐ same as Office/Business Address
Unit/Floor/Bldg No. Block No./Lot No./Phase No./Bldg Name Street Name Subdivision/Village/Purok/Sitio/Barrio
Barangay Town/Municipality/City/District/State Province/Region Country Zip Code
Plant Telephone Number* Mobile Number* Email Address*
Country Code-Provider Code-Phone No. Country Code-Area Code-Identifier-Phone No/Local
Instructions: All data fields should be completely and accurately filled-up, otherwise please indicate “NA” for Not Applicable and “N” for None. Those with asterisks are mandatory fields
REMINDER: Tampering with or misuse of this document is punishable under prevailing Philippine laws DBP Property
For Client’s Use Only
BB 0716.r2.2021
Customer Information File
Form
Corporate
Page 2
Name of Entity*
AUTHORIZED REPRESENTATIVE / TRANSACTOR / SIGNATORY DETAILS
☐ Authorized Representative ☐ Authorized Transactor ☐ Authorized Signatory
(1) Last Name* First Name* Suffix* Middle Name*
Date of Birth*
-
-
MM DD YYYY
Place of Birth* Sex* Citizenship*
☐ Male ☐ Philippines
Town/ Municipality / City Province / Country ☐ Female ☐ Others _________
Present Address*
House/Floor/Unit No. Block No./Lot No./Phase No./Bldg Name Street Name Subdivision/Village/Purok/Sitio/Barrio
Barangay Town/Municipality/City/District/State Province/Region Country Zip Code
Nature of Work/Business*
☐ Banking ☐ Financial Services ☐ Services ☐ Wholesale/Retail Trade
☐ Education ☐ Government ☐ Transport & Storage ☐ Others ___________
Source of Wealth*
` ☐ Allowance ☐ Donation ☐ Inheritance ☐ Retirement Benefit
☐ Business ☐ Pension ☐ Salary ☐ Others _________
Telephone Number* Mobile Number* E-mail Address*
Country Code-Area Code-Identifier-Phone No/Local Country Code-Provider Code-Phone No.
☐ Authorized Representative ☐ Authorized Transactor ☐ Authorized Signatory
(2) Last Name* First Name* Suffix* Middle Name*
Date of Birth*
MM DD YYYY
Place of Birth*
Town/ Municipality / City Province / Country
Sex* Citizenship*
☐ Male ☐ Philippines
☐ Female ☐ Others _________
Present Address*
House/Floor/Unit No. Block No./Lot No./Phase No./Bldg Name Street Name Subdivision/Village/Purok/Sitio/Barrio
Barangay Town/Municipality/City/District/State Province/Region Country Zip Code
Nature of Work/Business*
☐ Banking ☐ Financial Services ☐ Services ☐ Wholesale/Retail Trade
☐ Education ☐ Government ☐ Transport & Storage ☐ Others ___________
Source of Wealth*
` ☐ Allowance ☐ Donation ☐ Inheritance ☐ Retirement Benefit
☐ Business ☐ Pension ☐ Salary ☐ Others ___________
Telephone Number* Mobile Number* E-mail Address*
Country Code-Area Code-Identifier-Phone No/Local Country Code-Provider Code-Phone No.
I hereby certify that the above information is true and correct to the best of my knowledge and confirm that I fully understand and agree to be governed by the rules and
regulations of the Bank.
Signature over Printed Name / Date
Signature over Printed Name / Date
FOR BANK USE
CIF Number
Customer Contact:
☐ Walk-in
☐ Referred by:
Name & ID # _______________________
Relationship _______________________
Application: ☐ New ☐ Updating *Date: ______________
Validated against the Bank’s watchlist ☐ Yes ☐ No
If yes, ☐ OFAC/FATF ☐ PEP ☐ Others: ___________
(For FATCA Purposes) US Person ☐ Yes ☐ No
AR Rating ☐ Low ☐ Normal ☐ High
Authenticated by:
Approved by:
Signature over Printed Name / Date
Signature over Printed Name / Date
REMINDER: Tampering with or misuse of this document is punishable under prevailing Philippine laws. DBP Property
For Client’s Use Only
