AMDFormN01aRevisedJuly2013

BANGKOSENTRALNGPILIPINAS

ASSETMANAGEMENTDEPARTMENTTelephoneNos.3063422,30634233062914

BUYERSINFORMATIONSHEET(ForIndividuals)

(Pleasecompleterequiredinformation.IfnotapplicableputN/A.)

BUYERSPERSONALDATALastName: FirstName: MiddleName:

PermanentHomeAddress:(No.Street,Subdivision,Barangay,City/Municipality,Province)

HomeTel.No.: HomeOwnership:OwnedMortgagedRentedatP_____________LivingWithRelatives

PresentHomeAddress:(No.Street,Subdivision,Barangay,City/Municipality,Province)

HomeTel.No.:

DateofBirth: PlaceofBirth: Age: Sex: Male Female

CivilStatus:SingleMarriedAnnulledWidow/er LegallySeparated

No.ofDependent/s:

Nationality:

ACR/No.SIRV/SRRVNo.,ifapplicable

TIN:

FaxNo.:

CellphoneNo.:

EMailAddress:

GovernmentIssuedIDIssuedByandNo.:

DateandPlaceIssued:

IFEMPLOYED IFENGAGEDINBUSINESSCompany/Institution: BusinessorTradeName:

CompanyAddress: NatureofBusiness:

TelephoneNo.: BusinessAddress:

GrossMonthlyIncome: NetIncomefortheImmediatelyPrecedingYear:

OtherSourceofFamilyIncomeSource/NatureAmountperYear______________________P__________________________________________________

ReferencesNameAddressContactNo.____________________________________________________________________________________________

SPOUSESPERSONALDATALastName: FirstName: MiddleName: DateofBirth:

Citizenship: Age: TIN: CellphoneNo.: EmailAddress:

Company/Employer/BusinessName(ifselfemployed): Company/Employer/BusinessAddress: OfficeLandline:

EXISTINGLOANACCOUNTS/OUTSTANDINGCREDITS(Pleaseuseaseparatesheet,ifnecessary)TypeofLoan: Bank/FinancialInstitution/Creditor&Address:

OriginalAmount: MonthlyPayment: OutstandingBalance: MaturityDate:

OTHERASSETS(Pleaseuseaseparatesheet,ifnecessary) CREDITHISTORY

TypeofProperty/Investment:(e.g.house,car) Doyouhaveanexistingloanwithotherbanks,financialinstitutionsorgovernmentagenciessuchasPAGIBIG,GSISorSSS?YesNoIfyes,pleasegivedetailsandsubmitproofoflastamortizationpaymentAretherecases,pastorpending,civilorcriminal,filedagainstyouinvolvingnonpaymentofobligationsormishandlingorissuanceofbouncingchecks?YesNoIfyes,pleasestatethenatureandstatusofthecase.____________________________

Location/Description:

EstimatedValue:

CERTIFICATIONIhereby certify that theabove statementsare true, correctandcomplete to thebestofmyknowledgeandbeliefandherebyagree thatanymisrepresentationornondisclosureofamaterialfactshallbeagroundforthedisapprovalofmyoffer.IagreetonotifytheBSPofanychangeinmypersonalcircumstancesand/oranymaterialchangeinthedatastatedherein.IlikewiseauthorizetheBSPtoundertakewhateverinvestigationorverificationtocheckthevalidityorinformationcontainedherein.Lastly,Iunderstandthatitmaybeacriminaloffensepunishablebyfineorimprisonment,orboth,toknowinglymakeuntruthfulstatementsorrelatedfalsehoodsuponanymaterialmatterconcerninganyoftheabovestatementsunderthecriminallawsofthePhilippines._________________________________________________________DateSignatureOverPrintedName

JURAT DOCUMENTARYREQUIREMENTSRepublicofthePhilippines)CityofManila)S.S.SUBSCRIBEDANDSWORNTOBEFOREMETHIS______DAYOF_______,2011AT____________BY________________________________________________________________(NameofBuyer)Com.TaxCert.No.DateandPlaceofIssueDocNo._____________PageNo.____________BookNo.____________SeriesNo.___________

Putamarkontheitemssubmitted:()ProofofIncome(latestIncomeTaxReturn,Payslip,etc.)()CertificateofEmployment()DTICertificateofRegistration/BusinessPermit(photocopy)()OnepassportsizeIDpicture()GovernmentIssuedID&BIRTIN()StatementofBankAccountorPhotocopyofPassbook()BankCertificationonInvestment,ifany(photocopy)()FornonresidentalienAffidavitonTotalLandholdings()SpecialPowerofAttorney,ifrepresented

ForTCTNo._________________Location_________________

PastePassportSizeIDPhotoHere