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Annex B Application Form

This document is an application form for a proposed merger, consolidation, or purchase and assumption of assets and liabilities between two banks. It requests information about the type of transaction, the surviving or acquiring bank, contact information, and basic details about the applicant banks such as their names, addresses, types of banks, and presidents/chairmen. It also documents the board resolutions approving the transaction and lists the authorized signatories. An annex includes a joint declaration by the applicant banks stating that the information provided is true and complete, and that they will comply with all requirements and hold the regulatory agencies harmless.

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Christine Owapin
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71 views3 pages

Annex B Application Form

This document is an application form for a proposed merger, consolidation, or purchase and assumption of assets and liabilities between two banks. It requests information about the type of transaction, the surviving or acquiring bank, contact information, and basic details about the applicant banks such as their names, addresses, types of banks, and presidents/chairmen. It also documents the board resolutions approving the transaction and lists the authorized signatories. An annex includes a joint declaration by the applicant banks stating that the information provided is true and complete, and that they will comply with all requirements and hold the regulatory agencies harmless.

Uploaded by

Christine Owapin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Annex B

Application No. __________________________


(to be filled up by the Agency)

Type of Transaction  Merger  Consolidation  Purchase of


Assets & Assumption
of Liabilities (P&A)
Surviving Bank (if merger) _________________________________________________________
Proposed Name (if consolidation) _________________________________________________________
Acquirer (if P&A) _________________________________________________________
Contact Person and Contact No. _________________________________________________________

Information on Applicant Banks:

Bank 1 Bank 2
Name ______________________________ ____________________________
Type (e.g., Universal, ______________________________ ____________________________
Commercial, Thrift, Rural,
Cooperative)
______________________________ ____________________________
Address ______________________________ ____________________________

President ______________________________ ____________________________


Chairman of the Board ______________________________ ____________________________

Major Stockholders ______________________________ ____________________________


(include % of ownership) ______________________________ ____________________________
(add a separate sheet for SH
holding more than 10%)
______________________________ ____________________________
______________________________ ____________________________
______________________________ ____________________________
Transaction Approval:
Board Resolution No. ______________________________ ____________________________
Date ______________________________ ____________________________
Stockholders’ Resolution No. ______________________________ ____________________________
Date ______________________________ ____________________________

Authorized Signatories (as indicated in the Board Resolution of the transaction approval ):
[Name of Bank] [Name of Bank]

_________________________ ________________________
(Signature over Printed Name) (Signature over Printed Name)
Position: _________________
Position: ________________
(Add separate sheet if necessary)
JOINT DECLARATION AND UNDERTAKING

The ____________________________, a (type of bank) duly organized and existing under


Philippine laws, holding office at __________________________________________, represented
by its _______________, _____________________________, duly authorized for this purpose under
Board Resolution No. ______ dated __________ (Annex 1);

and

The ____________________________, a (type of bank) duly organized and existing under


Philippine laws, holding office at __________________________________________, represented
by its _______________, _____________________________, duly authorized for this purpose under
Board Resolution No. ______ dated __________ (Annex 2);

(collectively referred to as the “Proponent Banks”)

The Proponent Banks hereby declare, warrant, and undertake to the Philippine Competition
Commission, Philippine Deposit Insurance Corporation, Bangko Sentral ng Pilipinas, Securities
and Exchange Commission or Cooperative Development Authority (the “Agencies”) that:

1. The information provided and the documents submitted along with this application for
merger/consolidation/acquisition (the “Application”) based on the Harmonized List of
Requirements are true, correct and complete;

2. Should there be additional/revised documents required in the processing of the


Application, the Proponent Bank/s shall strictly comply within set deadlines from receipt
of Notice from the Agency requiring the same. The failure to comply with the Agency’s
requirements and to submit the said documents within the allowable period shall render
the Application denied and the application process terminated;

3. In case any document or information submitted by the Proponent Bank/s is found to be


false, untrue, misrepresenting, or misleading, the same shall render the clearance,
consent, certificate, or approval issued by any of the Agencies on the Application
revoked or denied.

4. All representations, information, and statements pursuant to the Application are the sole
responsibility of the Proponent Banks. The Proponent Banks shall indemnify, and hold the
Agencies, their directors, officers, employees, agents and representatives free and
harmless, against any and all claims, loss, damage, costs, and expenses of any nature
whatsoever, which may arise out of, or based upon, any deficiency, misrepresentation
or untrue statement in the Application by the Proponent Banks.

Authorized Signatories:

[Name of Bank] [Name of Bank]

_________________________ ________________________
(Signature over Printed Name) (Signature over Printed Name)

Position: _________________ Position: ________________

(Add separate sheet if necessary)

Prescribed Template – Unified Application with Undertaking


SUBSCRIBED AND SWORN TO before me, a Notary Public for and in _________________ this ___
day of ________________, by:

Name Competent Proof of Identity

Doc. No. ______:


Page No. ______:
Book No. ______:
Series of _____.

Prescribed Template – Unified Application with Undertaking

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