Exhibit 1

BANK CERTIFICATION REQUEST FORM

Date:
Branch Name

Name of Accountholder(s)

Currency Account Number/s Service Charge (Mode of Payment)

Peso Cash Debit Account No.

US Dollar Purpose

Others VISA Application Proof of Liquidity

_______
Others

Addressee’s Name and Address:

I/We hereby authorize the Bank to disclose information relative to my/our Deposit/Investment(s) Account(s) by virtue of this request for
issuance of a Bank Certification and the purpose stated herein.
I/We hereby waive my/our rights under Republic Act (RA) No. 1405 (Bank Secrecy Law), RA No. 6426 (Foreign Currency Deposit Act
of the Philippines), as may be amended from time to time, and such other relevant rules and regulations. I/We further release and
hold free and harmless the Bank, its directors, officers and employees from any and all liability that may arise from this disclosure.
I/We hereby certify that I/We am/are effecting the above request and, in case it is a joint account, I/We declare under the penalties of
perjury that my/our co-depositor/s is/are still living.

AUTHORIZATION CONFORME

This is to authorize _______________________________ Depositor _______________________ ______

whose signature appears below, to receive in my behalf, Printed Name and Signature Date
the above request.

Signature of Representative: _______________________ Co-depositor _______________________ ______

Printed Name and Signature Date

IDs Presented If coursed thru Overseas Office

FOR BANK USE ONLY

Overseas Officer _______________________ ______
Assisted By: Checked and Approved By: Printed Name and Signature Date
Signature Verified
By: Recipient _______________________ ______
Printed Name and Signature Date

Form No. G005 August ‘15