ALIFELONG MARKETING AND SERVICES, INC.

CUSTOMER INFORMATION SHEET

Version 1.0 s.2017

Customer Last Name First Name Middle Name

 Individual GABIOLA GABIOLA
Business name
 Business
Tax Identification No. AUTHORISED SIGNATORY
Last Name First Name Middle Name

Beneficial Owner Last Name First Name Middle Name

Contact Details Telephone Fax Mobile Mobile

Email FB

Current/Business Bldg/Unit Street Street

Number
Address
Barangay District/Locality

City/Municipality Zip Code Province Country (Def. Philippines)

Permanent Bldg/Unit Street Street

Number
Address
(If Individual Customer) Barangay District/Locality

City/Municipality Zip Code Province Country (Def. Philippines)

Personal Details, Date of Birth Nationality Source of Funds

(mm/dd/yyyy)
Source of Funds,
Employment or Name of Employer/Business
Business
(If Individual Customer) Bldg/Unit Street Street
Number
Barangay District/Locality

City/Municipality Zip Code Province Country (Def. Philippines)

Telephone Fax Mobile Email

Nature of
Business
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