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    AP CIUF With Data Privacy

    Uploaded by

    Emmanuel Catalan
    This document is a client information update form for updating contact and personal information of a planholder. It contains fields for the planholder's name, plan agreement numbers, phone numbers, email, mailing address, and signatures. It also includes clauses allowing the company to process the planholder's information to service the account, comply with legal obligations, and communicate via SMS regarding plan-related information. The planholder represents that the provided information is accurate and releases the company from liability regarding SMS communications.

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

    AP CIUF With Data Privacy

    Uploaded by

    Emmanuel Catalan
    34 views1 page
    This document is a client information update form for updating contact and personal information of a planholder. It contains fields for the planholder's name, plan agreement numbers, phone numbers, email, mailing address, and signatures. It also includes clauses allowing the company to process the planholder's information to service the account, comply with legal obligations, and communicate via SMS regarding plan-related information. The planholder represents that the provided information is accurate and releases the company from liability regarding SMS communications.

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    This document is a client information update form for updating contact and personal information of a planholder. It contains fields for the planholder's name, plan agreement numbers, phone numbers, email, mailing address, and signatures. It also includes clauses allowing the company to process the planholder's information to service the account, comply with legal obligations, and communicate via SMS regarding plan-related information. The planholder represents that the provided information is accurate and releases the company from liability regarding SMS communications.

    Copyright:

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

    AP CIUF With Data Privacy

    Uploaded by

    Emmanuel Catalan
    This document is a client information update form for updating contact and personal information of a planholder. It contains fields for the planholder's name, plan agreement numbers, phone numbers, email, mailing address, and signatures. It also includes clauses allowing the company to process the planholder's information to service the account, comply with legal obligations, and communicate via SMS regarding plan-related information. The planholder represents that the provided information is accurate and releases the company from liability regarding SMS communications.

    Copyright:

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

    CLIENT INFORMATION UPDATE FORM

    Date:
    Planholder’s _______________________________, __________________________________ _______ ___/___/___
    Name: (Last Name) (First Name) (MI) MM DD YY

    Plan Agreement (1) (3)


    Number/s (2) (4)

    Mobile/
    Cellphone -

    Home -

    Landline
    Office -

    (Area Code) (Telephone Number)


    Email

    Mailing Address

    By signing below, I/We hereby if and when applicable:

    1. Subject to the Data Privacy Act (RA 10173) and the corresponding banking/insurance regulations, I/we agree that the Company and/or its
    agents may process, obtain, collect, record, organize, store, update, modify, use, access, share and/or disclose (“Process”), information relating to
    me/us and/or my/our Plan(s) in order to (a) facilitate, monitor, improve the quality of, or otherwise service my account and such products, services,
    facilities and/or channels availed by me/us, and/or (b) to comply with legal, regulatory or other obligations of the Company under applicable local
    or foreign laws, rules and regulations (including but not limited to those relating to anti-money laundering, exchange of information among tax
    authorities, the United States Foreign Account Tax Compliance Act [FATCA] and/or common reporting standards) or as may otherwise be required by
    correspondent banks and/or financial industry bodies or associations, whether local or foreign. As used herein, the term “Company” shall include the
    parent BPI and its local or foreign branches, subsidiaries and affiliates (collectively, the BPI Group of Companies), and their respective agents,
    representatives and outsourced service providers and their respective outsourced providers under an obligation of confidentiality.
    2. Represent and warrant that all such information and/or documentation provided to Ayala Plans are true, correct, and not misleading.

    Also, I hereby authorize Ayala Plans to communicate to me via Short Messaging Service (SMS) regarding, among others, financial and
    plan-related information pertaining to my plan. I shall notify Ayala Plans in case of any changes in my cellphone number. I hereby release, indemnify
    and hold Ayala Plans free and harmless from any liability of whatsoever kind and nature in connection with the said authorization. I hereby declare
    under penalties of perjury that the above information is true and correct. Please recognize in any transaction the following Planholder’s signatures:

    Signature over printed name of Planholder

    1.___________________________________ 2._______________________________ 3._______________________________


    Note: All three (3) specimen signatures should be similar.

    11th floor BPI-Philam Life Makati, 6811 Ayala Avenue Makati City 1226
    Tel No. (632) 89-100 | (toll-free) 1800-188-89100 Fax No. (632) 816-9697
    E-mail:[email protected]

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