Company Certification and Employee List Form

GAP

HRP

MCC USE ONLY

COMPANY INFORMATION
Company Name:

Program Code: ____________________

Sub Program Code: _________________
Agent Code: ______________________
Company Code: ___________________
Total # of Turn Ins: _________________
3rd Line Embossing:
YES NO

Nature of Business:

Company Address:
HR Manager / Designated Officer:

Company Website:

Phone:

Contact Person:

If Satellite/Branch (please indicate head office):

Last Name

GOV-PUB PROGRAM

First Name

Middle Name

Birthdate
(MM/DD/YY)

Hiring Date
(MM/DD/YY)

Position / Level

Gross Annual Salary

1
2
3
4
5
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8
9
10
FOR METROBANK PERSONNEL ONLY

CERTIFICATION

This is to certify that the information shown in the above employee list of bona-fide regular employees of <__________________> is true and correct.
The Company, thru this Form, signifies intent to avail of the Metrobank Card Corporation (MCC) Human Resource Package (HRP), Government
Offices and Public Schools Program (GOV-PUB) or Group Application Program (G.A.P.) and unilaterally applies for an MCC credit card on behalf
of its employees. It is understood that MCC reserves the right to decline card issuance to any of the above listed employees that may be deemed
unqualified without need for explanation and that the Company shall continuously inform MCC in writing any addition or resignation / termination
/ retirement of any employee provided in the list at least 5 working days before date of effectivity. It is further certified that the above listed
employee information is the same as what appears in the respective 201 files. Moreover, pursuant to BSP Circular No. 706, which permits reliance
on a third party for purposes of the customer identification process, the procurement of customer identification, gathering of minimum information
and face-to-face contact, the Company hereby further certifies that it has conducted the necessary identification (both documentary and
face-to-face) and background verification for the named employees and the Company obtains, and keeps in its custody, all the minimum
information and/or identification documents required to be obtained from employees which upon request, may be furnished by the Company to
MCC in accordance with BSP Circular 706. (Updated Anti-Money Laundering Rules and Regulations)

Signature Over Printed Name/Date

Designation/Position

(PLEASE ATTACH A PHOTOCOPY OF THE COMPANY ID WITH SIGNATURE OF THE SIGNATORY)

REFERRER DETAILS:

Referrer's Name:

Head of Branch or Unit:

Referrer's Card Details:

Branch or Unit Name:

BH or BOO Signature:

Branch Code:

CBG/BLG/TBG Head Signature:

COMPANY DETAILS: (Mark with "x" all that applies)

[ _ ] COMPANY IS NOT A MBTC CLIENT

[ _ ] PAYROLL CLIENT
[ _ ] COMPANY IS MBTC CLIENT*
COMPANY ADDRESS ON RECORD:

[ _ ] OTHER MBTC RELATIONSHIP

PHONE NUMBER ON RECORD:

" This is to certify that the company details indicated is true and correct and that I have validated and confirmed
that the person who signed this template is an Authorized Signatory of this Company."
Branch Head/ BOO /Unit Head Name
*applicable to MBTC clients only

SIGNATURE
Approved/ Printed Date: March 2015