<!
DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Chinabank ni migs</title>
<style>
body {
width: 1200px;
margin: auto;
}
h1 {
letter-spacing: 1px;
line-height: 1px;
}
p{
letter-spacing: 1px;
line-height: 5px;
}
table {
width: 100%;
table-layout: fixed;
}
.input-group {
display: flex;
justify-content: space-between;
}
.input-group input {
padding: 15px;
border: 1px solid black;
}
.box {
border: 1px solid black;
padding: 10px;
width: 31%;
display: inline-block;
text-align: left;
}
</style>
</head>
<body>
<form>
<hr color="black" width="100%" size="5">
<table>
<tr>
<td><h1>CHINABANK</h1>
<p>www.chinabank.ph</p>
</td>
<td align="right">
<h1>CUSTOMER INFORMATION FILE</h1>
<p>FOR INDIVIDUAL/SOLE PROPRIETORSHIP</p>
<br>
<p>Customer ID no.________________________</p>
</td>
</tr>
</table>
<table width="105%">
<tr>
<td align="center" bgcolor="black" style="color: white;">
<b>PERSONAL INFORMATION</b></td>
</tr>
</table>
<table>
<tr class="input-group">
<input type="text" id="fullname" name="fullname"
placeholder="Name (Last name, First name, Middle name)"
style="width: 65%;padding: 10px; border: 1px solid black;"">
<input type="text" id="nickname" name="nickname"
placeholder="Nickname/Aliases"
style="width: 30%; padding: 10px; border: 1px solid black;"">
</tr>
<tr>
<input type="text" id="permanent_address" name="permanent_address"
placeholder="Permanent address (No./Street/District/City/Province/ZIP Code)"
style="width: 95%;padding: 10px; border: 1px solid black;"">
</tr>
<tr>
<input type="text" id="present_address" name="present_address"
placeholder="Present Address(No./Street/District/City/Province/ZIP Code)"
style="width: 95%;padding: 10px; border: 1px solid black;"">
</tr>
<tr>
<input type="text" id="email" name="email"
placeholder="E-mail Address"
style="width: 30%;padding: 10px; border: 1px solid black;"">
</tr>
<input type="text" id="fullname" name="fullname"
placeholder="Home Phone number"
style="width: 33%;padding: 10px; border: 1px solid black;"">
<input type="text" id="nickname" name="nickname"
placeholder="Mobile phone number"
style="width: 25%; padding: 10px; border: 1px solid black;"">
<tr>
<input type="text" id="number" name="number"
placeholder= "Date of Birth(dd/mm/yyyy"
style="width: 15%; padding: 10px; border: 1px solid black;"">
<input type="text" id="fullname" name="fullname"
placeholder="Place of birth"
style="width: 20%;padding: 10px; border: 1px solid black;"">
<td></td><div class="box">
<label for="status">Civil Status:</label>
<input type="radio" id="single" name="status" value="single"> Single
<input type="radio" id="married" name="status" value="married"> Married
<input type="radio" id="widowed" name="status" value="widowed"> Widowed
<style="width: 25%;padding: 10px; border: 1px solid black;"">
</div>
<input type="text" id="fullname" name="fullname"
placeholder="No. of dependents"
style="width: 10%;padding: 10px; border: 1px solid black;"">
</tr>
<tr>
<td></td>
<div class="box">
<label for="status">Gender:</label>
<br>
<input type="radio" id="Male" name="Gender" value="Male"> Male
<input type="radio" id="Female" name="Gender" value="Female"> Female
<style="width: 25%;padding: 10px; border: 1px solid black;"">
</div>
<div class="box">
<label for="status">Nationality:</label>
<br>
<input type="radio" id="Filipino" name="Name" value="Filipino"> Filipino
<input type="radio" id="Name" name="Name" value="Name"> ________________________
<style="width: 20%;padding: 10px; border: 1px solid black;"">
</div>
<div class="box">
<label for="status">Residency:</label>
<br>
<input type="radio" id="Resident" name="Name" value="Resident"> Resident
<input type="radio" id="Non-Resident" name="Name" value="Non-Resident"> Non-
Resident
<style="width: 20%;padding: 10px; border: 1px solid black;"">
</div>
<hr color="black" width="100%" size="5">
<td>
<tr><div class="box">
<label for="status">Highest Education Attainment:</label>
<input type="checkbox" name="education" value="High School"> High School
<input type="checkbox" name="education" value="College"> College
<input type="checkbox" name="education" value="Post-Graduate"> Post-Graduate
<input type="checkbox" name="education" value="Others"> Others
<td></td><tr><div class="box">
<label for="status"><b>Mother's Maiden Name</b> <i>(Last Name, First Name, Middle Name)</i>
</td>:</label>
<input type="text" id="fullname" name="fullname"
placeholder="Mother's Maiden Name"
<tr>
<td></td><tr><div class="box">
<label for="status"><b>TIN</b> </td>:</label><br><br>
<input type="text" id="fullname" name="fullname"
placeholder="TIN"
</tr>
<td></td><tr><div class="box">
<label for="status"><b>SSS/GSIS no.</b> </td>:</label><br><br><br><br><br><br><br><br>
<input type="text" id="fullname" name="fullname"
placeholder="SSS/GSIS no."
<td>
<tr><div class="box">
<label for="status">Source(s) of Funds:</label><br><br><br><br><br><br><br><br><br>
<input type= "checkbox" name="source_funds" value="Salary"> Salary
<input type="checkbox" name="source_funds" value="Business"> Business
<input type="checkbox" name="source_funds" value="Pension"> Pension
<input type="checkbox" name="source_funds" value="Regular Remittance"> Regular Remittance
<input type="checkbox" name="source_funds" value="Others"> Others
<tr><div class="box">
<label for="status"> Relationship with China Bank and Its Employees:(including China Bank
Subsidences)</label><br><br>
<input type="checkbox" name="source_funds" value="Director"> Director/Stockholder/Employee is a
aquintance<br>
<input type="checkbox" name="source_funds" value="Applicant"> Applicant is a
Director/Stockholder/Employee<br>
<input type="checkbox" name="source_funds" value="Not Applicable"> Not Applicable <br>
<b> Name and Unit of Director/Stockholder/Employee:________________
Relationship:________________ </b>
</tr>
<tr>
<hr color="black" width="100%" size="5">
<input type="text" id="nickname" name="nickname"
placeholder="SPOUSE INFO"
style="width:50%; padding: 300px; border: 5px solid black;"">
<td height = "10"><td colspan="144"><input type="text" id="nickname" name="nickname"
placeholder="Name (Last name, First name, Middle name)"
style="width: 38%; padding: 10px; border: 2px solid black;"">
<input type="text" id="nickname" name="nickname"
placeholder="Nickname/Aliases"
style="width: 35%; padding: 10px; border: 2px solid black;"">
</tr>
<tr>
<td height = "10"><td colspan="144"><input type="text" id="nickname" name="nickname"
placeholder="Employer/Business name"
style="width: 35%; padding: 10px; border: 2px solid black;"">
<input type="text" id="nickname" name="nickname"
placeholder="Job/Title position"
style="width: 35%; padding: 10px; border: 2px solid black;"">
<input type="text" id="number" name="number"
placeholder= "Date of Birth(dd/mm/yyyy)"
style="width: 15%; padding: 10px; border: 1px solid black;"">
<input type="text" id="Name" name="name"
placeholder= "Work Address"
style="width: 30%; padding: 30px; border: 1px solid black;"">
<input type="text" id="number" name="number"
placeholder= "Contact no."
style="width: 50%; padding: 30px; border: 1px solid black;"">
<table>
<tr class="section-title">
<td colspan="7"<td align="center" bgcolor="black" style="color: white;"><b> <center>Work Information
(or Business Information for Sole Proprietorship)</b></td>
</tr>
</td>
<td>
<td colspan="2">
<div class="box">
<label for="status">Employment Status:</label><br>
<input type="radio" name="employment_status" value="Employed"> Employed
<input type="radio" name="employment_status" value="Self-Employed"> Self-Employed
<input type="radio" name="employment_status" value="Retired"> Retired
<input type="radio" name="employment_status" value="Others"> Others
</td>
<td colspan="2">
<div class="box">
<label for="status">Gross Monthly Income:</label><br>
<input type="radio" name="income" value="Below PHP 10,000"> Below PHP 10,000<br>
<input type="radio" name="income" value="PHP 10,000 - 19,999"> PHP 10,000 - 19,999 <br>
<input type="radio" name="income" value="PHP 20,000 - 49,999">PHP 20,000 - 49,999 <br>
<input type="radio" name="income" value="PHP 50,000 - 99,999"> PHP 50,000 - 99,999<br><br><br>
</td>
<td>
<td>
<input type="text" id="number" name="number"
placeholder= "Years in work Business"
style="width: 50%; padding: 30px; border: 1px solid black;"">
<tr>
</td>
<td>
<input type="text" id="number" name="number"
placeholder= "Employer Business Name"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<td>
<td><input type="text" id="number" name="number"
placeholder= "Nature of Work Business"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<td>
<td><input type="text" id="number" name="number"
placeholder= "Job Title Position"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<tr>
</td>
<td>
<input type="text" id="number" name="number"
placeholder= "Work Phone no."
style="width: 150%; padding: 30px; border: 1px solid black;"">
<td>
<td><input type="text" id="number" name="number"
placeholder= "Work E-mail Address(if any)"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<td>
<td><input type="text" id="number" name="number"
placeholder= "Date of Registration(For sole prop)"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<tr>
</td>
<td>
<input type="text" id="number" name="number"
placeholder= "Work
Address(Floor/Department/Building/No./Street/City/Province/Country/ZIP Code)"
style="width: 700%; padding: 30px; border: 1px solid black;"">
</tr>
</td>
<table>
<tr class="section-title">
<td colspan="10"<td align="center" bgcolor="black" style="color: white;"><b>
<center>CERTIFICATION</b></td>
</tr>
<td>
<tr>
<td colspan="10" height = "70">
<p>I hereby certify that the information provided in this form is true, correct, accurate, and complete
<br><br><br><br> I understand that any false statements/information/invalid documents herein may be
a ground for disapproval or immediate closure of my bank account(s) <br><br><br><br>I hereby agree
to be bound by my account(s) or with China Bank Corporation governed by the terms and conditions
set forth by the Bank. <br><br><br><br> I also agree to abide by the rules and regulations of the
Bangko Sentral ng Pilipinas and the Bankers Association of the Philippines.</p>
<br><br><br><br><br><br>
<p><center>Customer's Signature / Date
</tr>
</td>
<td colspan="4">
<div class="box">
<label for="status">IDs Presented :</label><br>
<input type="checkbox" name="id_presented" value="School/Company ID"> School/Company ID <br>
<input type="checkbox" name="id_presented" value="Gov't/GOCC ID"> Gov't/GOCC
ID <br>
<input type="checkbox" name="id_presented" value="Driver License"> Driver License
<br>
<input type="checkbox" name="id_presented" value= "Passport"> Passport </td><br><br><br>
</td>
<td colspan="4">
<div class="box"><br>
<label for="status">IDs Presented :</label><br>
<input type="checkbox" name="id_presented" value="GSIS e-Card"> GSIS e-Card
<br>
<input type="checkbox" name="id_presented" value="SSS ID">SSS ID <br>
<input type="checkbox" name="id_presented" value="Senior Citizen Card"> Senior
Citizen Card <br>
<input type="checkbox" name="id_presented" value="Postal ID"> Postal ID
<input type="checkbox" name="id_presented" value="Voter's ID"> Voter's ID </td>
<tr>
<td colspan="4">
<div class="box">
<label for="status">IDs Presented :</label><br>
<input type="checkbox" name="id_presented" value="NBI/ Police Clearance"> NBI/ Police Clearance
<br>
<input type="checkbox" name="id_presented" value="Barangay Certification"> Barangay Certification
<br>
<input type="checkbox" name="id_presented" value="PRC ID"> PRC ID <br>
<input type="checkbox" name="id_presented" value="OFW ID"> OFW ID <br>
<input type="checkbox" name="id_presented" value="OWWA ID"> OWWA ID </td>
<tr>
<td>
<td>
<td>
<td>
<td colspan="4">
<div class="box">
<label for="status">IDs Presented :</label><br>
<input type="checkbox" name="id_presented" value="ACR/ ICR No."> ACR/ ICR No. <br>
<input type="checkbox" name="id_presented" value="Sp. Retirement"> Sp. Retirement <br>
<input type="checkbox" name="id_presented" value="DTI Certificate of REgistration (Sole Prop)"> DTI
Certificate of REgistration (Sole Prop) <br>
<input type="checkbox" name="id_presented" value="Application for Bussiness Name (Sole Prop)">
Application for Bussiness Name (Sole Prop) <br>
<input type="checkbox" name="id_presented" value="Others"> Others
</td>
</tr>
<td>
<input type="text" id="number" name="number"
placeholder= "Remarks"
style="width: 980%; padding: 30px; border: 1px solid black;"">
<tr>
</td>
<td>
<input type="text" id="number" name="number"
placeholder= "Introduce by/Date"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<td>
<td><input type="text" id="number" name="number"
placeholder= "Interview by/Date"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<td>
<td><input type="text" id="number" name="number"
placeholder= "Signature Verified by/Date"
style="width: 150%; padding: 30px; border: 1px solid black;"">
<td>
<td><input type="text" id="number" name="number"
placeholder= "Approved by/Date"
style="width: 150%; padding: 30px; border: 1px solid black;"">
</table>
</form>
</body>
</html>
