Customer Information Sheet
Customer Information Sheet
Customer Information Sheet
Name:
(Surname) (First Name) (Middle Name)
Age: Sex: Birthday: Nationality:
Address Abroad (if Any): Tel No. (Abroad, if any):
D. This is to Certify that the information above are true and correct.
_______________________________________ ________________________________________________
Buyer’s signature over printed name Spouse’s signature over printed name
TIN: _________________________________________________ TIN: ____________________________________________________
Res Cert/ Passport No. __________________________________ Res Cert/ Passport No._____________________________________
Date & Place Issued: ____________________________________ Date & Place Issued:_______________________________________
____________________________________________
Atty-in-fact Signature over printed name (if applicable)
Address: ____________________________________________________________________
Tel Number: ____________________________ Mobile Number: ______________________
Res Cert/Passport No. _____________________ Date & Place Issued___________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -To be Filled-Out by AO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. UD SU: _________________________________ HM/UT: _________________________________ BL/UN: _________________________________
F-SEL-CRMD001
ver(01) 09/23/2013
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