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Deposit Application
Customer Information Sheet — please fill out all required fields marked with *.
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Deposit Application
*Branch
Select Branch
Head Office Lipa
Bauan
Rosario
Ibaan
San Juan
Mataas na Kahoy
DOSRI Classification
Non-DOSRI
Employee
DOSRI
Related Party
Entity Type
Individual
Non-Individual
Personal Information
*Last Name
*First Name
Middle Name
*Present Address
*Resident Since (MM-YYYY)
*SSS No. or GSIS No.
District/Town
City/Province
Country
*Nationality
*Tax Identification No. (TIN)
Permanent Address (if different from Present Address)
*Citizenship
*Email Address
District/Town
City/Province
Country
Social Network Link
*Mailing Address
Present
Permanent
Business
*Date of Birth
Place of Birth
*Home Ownership
Owned
Living with Relatives
Rented
Mortgaged
Free Use
Amount (if Rented/Mortgaged, per month)
*Residence Phone No.
*Mobile Phone No.
*Business Phone No.
*Nature of Work/Business
*Employer
*Employer Address
*Business Name (If Self-employed/Non-Individual)
*Business Address
Job Designation
Clerical/Non-Officer/Rank and File
Contractual/Probationary
Mgr/Supervisor/Middle Level
Top Management/Senior Level
Government (Elected/Appointed)
Licensed Professional
Religious Leader
Owner
OTHERS
*Source of Funds (Check all that apply)
Allowance
Business
Commission
Donations/Contributions & the like
Campaign Funds
Interest on Savings/Placements/Investments
Pension
Regular Remittances
Salary
OTHERS
*Date Hired/Start of Business
*Gross Monthly Income
Under Php10,000
Php10,000 - Php49,999
Php50,000 - Php249,999
Php250,000 - Php499,999
Php500,000 - Php999,999
Php1,000,000.00 and above
*Profession/Occupation
*Employment Status
Employed
Private Sector
Public Sector
Self-Employed
Not Employed
Retired
Student
OTHERS
Other Personal Information
Nickname
Gender
Select
Male
Female
Philippine Resident
Yes
No
If no, country of residence
Products to be availed of
Educational Attainment
Select
Post Graduate
College Degree
Associate Degree
College Level
High School Graduate
High School Level
Elementary Graduate
Elementary Level
Vocational
None
Marital Status
Select
Single
Married
Annulled
Divorced
Separated
Widow
Widower
No. of Cars Owned
No. of Credit Cards
Types of Account with Lipa Bank
Savings
Time Deposit
Agri-Loan
Industrial Loan
Real Estate Loan
Housing Loan
Salary Loan
Commercial Loan
Other Loan
Types of Account with Other Banks
Savings
Checking
Time Deposit
Auto Loan
Housing Loan
Other Loan
Investment
Credit Card
None
Car Ownership
Select
Owned
Rented
Used Free
Mortgaged
Amount (if Rented/Mortgaged, per month)
Mother's Maiden Name
Father's Name
Are you an Officer, Director, Stockholder of a Company?
No
Yes
Spouse / Beneficiary / Authorized Signatory
For Spouse
For Beneficiary/Authorized Signatory (Non-Individual)
1.
2.
3.
4.
Other Instructions/Remarks
I hereby certify that the information provided is true, accurate and complete, and I agree to notify/update the bank of any change in the information supplied in this form.
*Date
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