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    Customer Information Form PDF

    Uploaded by

    Cheryl Bering
    This document contains a customer information sheet for Cheryl Bering Roamar. It lists her personal details such as name, contact information, address, date of birth, nationality, and source of funds. It also provides spaces to record the customer's ID details, corporate papers if applicable, comments, actions taken, and details of the intake personnel who processed the form. The information sheet is used to collect know-your-customer information when opening an account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Customer Information Form PDF

    Uploaded by

    Cheryl Bering
    38 views1 page
    This document contains a customer information sheet for Cheryl Bering Roamar. It lists her personal details such as name, contact information, address, date of birth, nationality, and source of funds. It also provides spaces to record the customer's ID details, corporate papers if applicable, comments, actions taken, and details of the intake personnel who processed the form. The information sheet is used to collect know-your-customer information when opening an account.

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    customer_information_form.pdf

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    This document contains a customer information sheet for Cheryl Bering Roamar. It lists her personal details such as name, contact information, address, date of birth, nationality, and source of funds. It also provides spaces to record the customer's ID details, corporate papers if applicable, comments, actions taken, and details of the intake personnel who processed the form. The information sheet is used to collect know-your-customer information when opening an account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    38 views1 page

    Customer Information Form PDF

    Uploaded by

    Cheryl Bering
    This document contains a customer information sheet for Cheryl Bering Roamar. It lists her personal details such as name, contact information, address, date of birth, nationality, and source of funds. It also provides spaces to record the customer's ID details, corporate papers if applicable, comments, actions taken, and details of the intake personnel who processed the form. The information sheet is used to collect know-your-customer information when opening an account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ALIFELONG MARKETING AND SERVICES, INC.

    CUSTOMER INFORMATION SHEET


    Version 1.0 s.2017

    Customer Last Name First Name Middle Name


    x Individual
     Roamar Cheryl Bering
    Business name
     Business
    Tax Identification No. AUTHORISED SIGNATORY
    Last Name First Name Middle Name

    Beneficial Owner Last Name First Name Middle Name


    Roamar Cheryl Bering
    Contact Details Telephone Fax Mobile Mobile
    4950171 n/a 09227727244
    Email FB
    [email protected] [email protected]
    Current/Business Bldg/Unit Street Street

    Address n/a Number n/a


    Barangay District/Locality
    n/a n/a
    City/Municipality Zip Code Province Country (Def. Philippines)
    n/a n/a n/a n/a
    Permanent Bldg/Unit Street Street

    Address ----- Number 2nd Street , Purok Sambag


    Barangay District/Locality
    (If Individual Customer)
    Canjulao Lapu- Lapu City
    City/Municipality Zip Code Province Country (Def. Philippines)
    LLC 6015 Cebu Phils.
    Personal Details, Date of Birth Nationality Source of Funds

    Source of Funds,
    (mm/dd/yyyy) Filipino
    03/23/1977 Remittance
    Employment or Name of Employer/Business
    Business n/a
    (If Individual Customer) Bldg/Unit Street Street
    n/a Number n/a
    Barangay District/Locality
    n/a n/a
    City/Municipality Zip Code Province Country (Def. Philippines)
    n/a n/a n/a n/a
    Telephone Fax Mobile Email
    n/a n/a n/a n/a
    Nature of
    Business Remittance
    Signature 1st Copy 2nd Copy 3rd Copy
    (Please sign 3 times)

    DO NOT FILL UP BEYOND THIS POINT (FOR ALIFELONG INTAKE PERSONNEL ONLY)
    ID(s) Presented Primary IDs (Passport/ACR only if Non-Filipino) Secondary IDs
    List down ID Type,
    Number, Date of Issue,
    Date of Expiry
    Corporate Papers  DTI Certificate No.,  SEC Certificate No. & Date of Issue Articles of Incorporation
    Date of Issue AND Expiry Date Submitted: _________________
    Latest GIS, dated ______________ Corporate Secretary’s Authorisation
    Date Submitted: _________________ Date Submitted: __________________
    Comments Action Taken CUSTOMER ID
     Accept  Deny
    Received By Processed By Approved By System Upload By

    Date Date Date Date

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