Know Your Customer (KYC) Form 1

In compliance with the Anti-Money Laundering Act (AMLA)

For Corporate Client:
Business Name: _______________________________________________ Telephone Nos: ___________________
Principal Business Address: ______________________________________________________________________________________
Nature of Business: ______________________________________________________ TIN: __________________________________
List of Directors/Partners: __________________________________________ ____________________________________________
__________________________________________ ____________________________________________
__________________________________________ ____________________________________________
List of Principal Stockholders owning at least 2% of the capital stock:
__________________________________________ ____________________________________________
__________________________________________ ____________________________________________
__________________________________________ ____________________________________________
Beneficial owners, if any:
_______________________________________________________________________________________
Name of Authorized Representative: _______________________________________________________________________________
Position: _______________________________________________________ Telephone No: _________________________________
Form completed by: ______________________________________________ Position: _____________________ Date: ____________
Policy No: ____________________________________________________________________________________________________
(Please attach copy of Articles of Incorporation/Partnership and By-Laws)