Sei sulla pagina 1di 2

Date and time of receipt

THE PHILIPPINE STOCK EXCHANGE, INC.


PSE Tower, One Bonifacio High Street
28th Street corner 5th Avenue, Bonifacio Global City, Taguig City
Tel. No. 876-4888
Website: http://www.pse.com.ph
EDGE Website: http://edge.pse.com.ph

APPLICATION FORM FOR RSA SECURITY TOKEN


(PSE EDGE RSA Form-01)

INSTRUCTIONS
1. The Application Form for RSA Security Token will be accomplished by the System Administrator for each listed company
authorized user.
2. Completely fill-out the Application Form for RSA Security Token. Incomplete forms will not be processed.
3. System Administrators must read and sign the RSA Security Token Guidelines.
4. Upon completion of items 1 and 2, submit the form to the Disclosure Department.
5. Only the System Administrator shall be recognized as the signatory on the Authorized Officer section of this request form.
6. The System Administrator will be notified once the RSA Security Token is available.
7. Only the System Administrator or his/her authorized representative shall be allowed to pick up the RSA Security Token.
The authorized representative should bring a valid ID, authorization letter and a valid ID of the System Administrator.
Acceptable valid IDs include: Company ID, Passport, Driver’s License, PRC ID, SSS ID or other government-issued IDs.
8. By submitting this form, the System Administrator and users consent to the collection, recording, storage, use, disclosure,
and processing by the PSE of their personal and/or sensitive personal information for the purpose of the RSA Security
Token application and for purposes relevant or incidental thereto. The authorized representative is also required to give
consent for the processing of his information which consent may be stated in the authorization letter. Likewise, it is the
obligation of the listed company to obtain the consent of individuals whose personal and sensitive personal information
are disclosed to the PSE authorizing the PSE to collect, use, disclose, and process the said information for disclosure
purposes.
9. For inquiries, call the Disclosure Department at 876-4740 to 4745.

APPLICANT’S INFORMATION
Listed Company:

Business Address:

System Administrator: Telephone No. Fax No. Email Address:


APPLICATION TYPE
NEW TOKEN REPLACEMENT OF TOKEN

Reason: Reason:

User: User:

DEACTIVATION OF TOKEN REACTIVATION OF TOKEN

Reason: Reason:

User: User:

NOTIFICATION
RE-ASSIGNMENT OF TOKEN

Reason:
User ID:
Old User:
New User:

Name of Listed Company


Name of System Administrator
Date
Signature

FOR PSE USE ONLY


IRD TD
Date Endorsed to TD: RSA Serial Number: Expiry Date:
Date Completed: Assigned by: Date:
Processed by: Approved by Date:

LISTED COMPANY
Received by:
Date Received:

PSE EDGE RSA Form-01


Control Number: RSA _______________