RBWM 8Aug2017 0298 HSBC Account Opening Form · PDF fileRBWM_8Aug2017_0298 HSBC Account...

RBWM_8Aug2017_0298 HSBC Account Opening FormCUSTOMER INFORMATION FORM

Do you have a relationship with HSBC outside the Philippines?

D D - M M M - Y Y Y Y D D - M M M - Y Y Y Y


APPLICANT 1

Account Package

No Yes HSBC Customer No. / HSBC Credit Card No.

No Yes List country(ies) outside Philippines below and indicate branch

Advance Premier Mass

Are you an existing HSBC Philippines customer?

______________________________________

First Name:

Former + Maiden Name:

Are you an existing HSBC Philippines customer?

APPLICANT 2

No Yes HSBC Customer No. / HSBC Credit Card No.

Title:

Country: PHL Others ________________

Legally Separated/ Divorced Living Together

City and Country of Birth: City and Country of Birth:

Other Nationality(ies):

Marital Status: Single Married Widowed

Legally Separated/ Divorced Living Together

Nationality:

Other Nationality(ies):

Nationality:

Advance Premier Mass

Former + Maiden Name:

Other Name(s): (aliases or name in another language, if any)

Title:

First Name:

Middle Name:

Surname + Suffix:

Gender: Male Female

No Yes List country(ies) outside Philippines below and indicate branch

Do you have a relationship with HSBC outside the Philippines?

Gender: Male Female

Other Name(s): (aliases or name in another language, if any)

Middle Name:

Surname + Suffix:

______________________________________

Account Package

Marital Status: Single Married Widowed

CURRENT RESIDENTIAL ADDRESS (Room No./Office Name,

Bldg./House No., Street Subd./Brgy./District, Town, City/Province)

CURRENT RESIDENTIAL ADDRESS (Room No./Office Name,



1. PERSONAL DETAILS

Please indicate NA if not applicable.

Postal Code: ____________ Postal Code: ____________

At this address

since

(dd-mmm-yyyy)

At this address

since

(dd-mmm-yyyy)

Date of Birth

(dd-mmm-yyyy)

Date of Birth

(dd-mmm-yyyy)

INTERNAL - Issued by HSBC Savings Bank (Philippines) Inc.

Member of the Philippine Deposit Insurance Corporation

Maximum Deposit Insurance for Each Depositor Php500,000 of 10




Length of Stay:


PREVIOUS RESIDENTIAL ADDRESS (Room No./Office Name,


*State address history for the past 3 years, if staying at present

address for less than 3 years.

PERMANENT RESIDENTIAL ADDRESS (Room No./Office Name,

Bldg./House No., Street,Subd./Brgy./District, Town, City/Province)

*Complete only if different to your current residential address

PERSONAL DETAILS continued

APPLICANT 2


Postal Code: ____________Postal Code: ____________


APPLICANT 1PERMANENT RESIDENTIAL ADDRESS (Room No./Office Name,

Bldg./House No., Street,Subd./Brgy./District, Town, City/Province)

*Complete only if different to your current residential address

PREVIOUS RESIDENTIAL ADDRESS (Room No./Office Name,


*State address history for the past 3 years, if staying at present

address for less than 3 years.

At this address

since

(dd-mmm-yyyy)

At this address

since

(dd-mmm-yyyy)

Length of Stay: __________ years _________ months Length of Stay: __________ years _________ months

Postal Code: ____________

Length of Stay: __________ years _________ months





__________ years _________ months

Country: PHL Others ________________ Country: PHL Others ________________











Residence Phone 1 Residence Phone 1

Residence Phone 2 Residence Phone 2

Office Phone No. Office Phone No.

Country Code Area Code Phone No.

Any other country/ies that you often visit , study in, have ownerships

(e.g. properties, Safety Deposit Boxes, businesses, etc. ) or have

business with/in?

APPLICANT 1

Country Code Area Code Phone No.

PERSONAL DETAILS continued

Last

Email address:

3. DOCUMENTARY DETAILS

APPLICANT 2Government ID type: ID number:

Tax Identification No.

Country (ies) of Tax Residence:

Email address:

Government ID type: ID number:

ID Expiry Date: Place of Issue: (dd-mmm-yyyy)

SSS or GSIS No.

Tax Identification No.

Country (ies) of Tax Residence:

Middle

Last

Father's Complete Name

First

Any other country/ies that you often visit , study in, have ownerships

(e.g. properties, Safety Deposit Boxes, businesses, etc. ) or have

business with/in?

MiddleFirst

2. CONTACT DETAILS

APPLICANT 1

APPLICANT 2

SSS or GSIS No.

If below 18 years old, please supplement the following details:

ID Expiry Date: Place of Issue: (dd-mmm-yyyy)

Guardian's Complete Name(if different from Father/ Mother's Name)

First Middle Last

Guardian's Complete Name(if different from Father/ Mother's Name)

First Middle Last

Guardian's Date

of Birth(dd-mmm-yyyy)

Guardian's Date

of Birth(dd-mmm-yyyy)

First Middle Last

First Middle

If below 18 years old, please supplement the following details:

Father's Complete Name

Mother's Date of

Birth(dd-mmm-yyyy)

Mother's Date of

Birth(dd-mmm-yyyy)

Last

Mother's Complete Name Mother's Complete Name

Father's Date of

Birth(dd-mmm-yyyy)

Father's Date of

Birth(dd-mmm-yyyy)

Mobile No. Mobile No.





Employee Business Owner *Key Controller


Employer's/Business Name:

Nature of Business:

Employment Type

*Key Controller is a person who exercises control over a

company/entity e.g. CEO, Chairman, CFO

Job Title (e.g. VP Human Resources)

Full-time Self-employed Student; Year of

Graduation: ___________

Part-time Professional Validation is required

(i.e. School ID,

Overseas Housewife proof of enrolment)

Filipino

Worker Unemployed Retired

*Key Controller is a person who exercises control over a

company/entity e.g. CEO, Chairman, CFO

Employer/ Business Address

Employer's/Business Name:

Nature of Business:

APPLICANT 2

4. EMPLOYMENT DETAILS

Employment Status

Year(s)________

Monthly Income (PHP)

Household Monthly Income Level (PHP):(e.g. joint income of spouses, income of Head of the

Family with other related family members)

Job Tenure - Previous Employer Year(s)________

Employment Status

Full-time Self-employed Student; Year of

Graduation: ___________

Part-time Professional Validation is required

(i.e. School ID,

Overseas Housewife proof of enrolment)

Filipino

Worker Unemployed Retired



Name of Previous Employer

APPLICANT 1


Employment

Start Date(dd-mmm-yyyy)

Employment

Start Date(dd-mmm-yyyy)

Employment Type

Employee Business Owner *Key Controller

Job Title (e.g. VP Human Resources)

If Professional, please specify (e.g. Lawyer) If Professional, please specify (e.g. Lawyer)

Name of Previous Employer

Job Tenure - Previous Employer

Monthly Income (PHP)

Household Monthly Income Level (PHP):(e.g. joint income of spouses, income of Head of the

Family with other related family members)

Employer/ Business Address






Expected Total Relationship Balance: Expected Total Relationship Balance:

Net Worth (i.e. Source of Wealth) refers to the ORIGIN of all existing

cash / wealth including those that will not be deposited in HSBC.

Please tick all that apply.

Net Worth (i.e. Source of Wealth) refers to the ORIGIN of all existing

cash / wealth including those that will not be deposited in HSBC.

Please tick all that apply.

Contribution/Allowance from Winnings from Lottery/

family members/individuals Betting/Casino

PHP ____________ PHP ____________

Earnings/Savings from Earnings/Savings from

practice of Profession Employment Income

PHP ____________ PHP____________

Main Country where net worth has been accumulated: Main Country where net worth has been accumulated:

Total Net Worth PHP



PHP ____________ PHP ____________

Earnings/Savings from Sale of Property/

Business Income Business

PHP ____________ PHP ____________

Retirement/Pension Inheritance

PHP ____________ PHP ____________



PHP ____________ /annum PHP ____________ /annum


PHP ____________ /annum PHP ____________/annum

Purpose of Account Opening Purpose of Account Opening

Earnings/Savings from Earnings/Savings from

practice of Profession Employment Income

PHP ____________ PHP____________

Earnings/Savings from Sale of Property/

Business Income Business

PHP ____________ PHP ____________


PHP ____________ PHP ____________

Value of Assets/Wealth/Investments

(trading of securities/ currencies,

franchises, inventions, royalties, patents,

real estate, jewelry)

PHP

PHP

Others (please specify):

Php

Value of Assets/Wealth/Investments

(trading of securities/ currencies,

franchises, inventions, royalties, patents,

real estate, jewelry)


Total Net Worth

Active Wealth/Investments (trading of

securities/currencies, franchises, inventions,

royalties, patents, real estate, jewelry)

Practice of Profession Employment Income


Business Income Sale of Property/Business


Source of Funds refers to the MEANS TO FUND the account and all

other regular sources of future deposits (ongoing source). Please tick

all that apply.

Practice of Profession Employment Income


Business Income Sale of Property/Business


Active Wealth/Investments (trading of

securities/currencies, franchises, inventions,

royalties, patents, real estate, jewelry)

PHP

Source of Funds refers to the MEANS TO FUND the account and all

other regular sources of future deposits (ongoing source). Please tick

all that apply.

Total Source of Funds Php

PHP

Total Source of Funds




PHP ____________/annum PHP ____________/annum




APPLICANT 2

PHP

5. CUSTOMER PROFILE

APPLICANT 1





Which country (ies) do the funds originate from?

6. INITIAL FUNDS

Original Source of Funds being used to open this account:

Salary Savings Investments

Inheritance Allowance Pensions

Others; please specify: ____________________________

Method of Transfer: Cash Non-cash Both

Which country (ies) do the funds originate from?

Cash

Method of Transfer: Cash Non-cash Both

Inward Remittances Outward Remittances

Deb

itC

red

it

Local

(within the Philippines)

APPLICANT 1

7. ANTICIPATED ACCOUNT ACTIVITY

Local


Transaction Amount Number of

Transactions

Remarks (e.g. child student fees)

Types of expected account activity:

Type of expected activity

per annum

Types of expected account activity:

Cash Deposit Cash withdrawal Cash Deposit Cash withdrawal

Inward Remittances Outward Remittances

APPLICANT 1

Original Source of Funds being used to open this account

Salary Savings Investments

Inheritance Allowance Pensions

Others; please specify: ____________________________

APPLICANT 2

International

(Specify countries)

Local


International

(Specify countries)

Type of expected activity

per annum

AP

PLI

CA

NT

1

Cre

dit

International

(Specify countries)

De

bit

AP

PLI

CA

NT

2

Local


APPLICANT 2

Cash Non-Cash

International

(Specify countries)

Non-Cash

Transaction Amount Number of

Transactions

Remarks (e.g. child student fees)





8. CONNECTED PARTIES

*A Contributor is defined as an individual (e.g. a spouse or parent) that

provides more than USD 10k per month which accounts for over 50% of

customer's source of funds. In the case of Students and Insurance policies, this

refers to contributions that are equal to or greater than USD 75k per year.

No Yes Complete a Personal Details Form and submit

a valid ID and proof of residential address

APPLICANT 1

Mailing / Correspondence Address (This will be the primary address to be

used for bank initiated correspondences)

Current Address Permanent Address Business Address

Mailing / Correspondence Address (This will be the primary address to be

used for bank initiated correspondences)

Current Address Permanent Address Business Address

Checking Account Deposit Currency: Savings Account Deposit Currency:

10. DEPOSIT PRODUCTS

APPLICANT 2

Will you have any Connected Parties? (Power Of Attorney,

Supplementary Card Holder, Safety Depost Box Deputy, *Contributor)

Relationship:

Name:

No Yes Complete a Personal Details Form and submit

a valid ID and proof of residential address

Do you have any relatives that hold senior positions in

government (executive, legislative & judiciary) and/or the

uniformed service (police or military)?

Name:

No Yes If yes, please state the relative’s name

and how you are related.

No Yes If yes, please state the relative’s name

and how you are related.

Do you have any relatives that hold senior positions in

government (executive, legislative & judiciary) and/or the

uniformed service (police or military)?

Relationship:

Will you have any Connected Parties? (Power Of Attorney,

Supplementary Card Holder, Safety Depost Box Deputy, *Contributor)

Bank Relationships Other than HSBC:

*A Contributor is defined as an individual (e.g. a spouse or parent) that

provides more than USD 10k per month which accounts for over 50% of

customer's source of funds. In the case of Students and Insurance policies, this

refers to contributions that are equal to or greater than USD 75k per year.

Bank Name

APPLICANT 1 APPLICANT 2

APPLICANT 1

Bank NameType of Relationship

(e.g. Credit Card, Housing Loan, etc.)

Bank Relationships Other than HSBC:

9. MAILING/CORRESPONDENCE ADDRESS

APPLICANT 2

Type of Relationship (e.g. Credit Card, Housing Loan, etc.)





All your existing and subsequent deposit accounts will be automatically subscribed to SMS alerts. HSBC will send an SMS to notify

you whenever there is deposit or withdrawal to the bank account.

12. HSBC ALERTS

Do you plan/intend to stay in the Philippines for an aggregate

period of more than 180 days? Yes No

Reason for opening an account in the Philippines:

In view of my HSBC (The Bank) account opening, I agree and understand that I will receive by electronic means only, my account

opening confirmation, advices, statement of accounts and confirmations of transactions executed upon my instructions to the Bank

and such other banking services as may be specified by the Bank from time to time. I agree that I shall check the account

statements, advices, confirmations and communications relating to my Account through your internet banking services at least

once a month and undertake to immediately inform you of any errors, discrepancies, omissions or inaccuracies.I agree to examine

each advice, confirmation, statement of account and notify the Bank within ten (10) days from receipt or date of availability for

viewing, in the case of bank advices and confirmations, or sixty (60) days from posting, in the case of periodic statement of account,

a written notice of alleged errors or omissions therein. I acknowledge and agree that should I fail to give the Bank any such written

notice of errors or omissions within the period aforementioned, I waive any right to raise any objection to or to contest and shall be

deemed to have agreed to the correctness and validity of said advice, confirmation or statement of account.

APPLICANT 1

Have you stayed in the Philippines for an aggregate period of

more than 180 days in any calendar year? Yes No

Do you plan/intend to stay in the Philippines for an aggregate

period of more than 180 days? Yes No

Reason for opening an account in the Philippines:

11. PLEASE COMPLETE IF YOU ARE A NON-RESIDENT

APPLICANT 2

Have you stayed in the Philippines for an aggregate period of

more than 180 days in any calendar year? Yes No

AGREEMENT TO BANK TERMS AND CONDITIONS

I declare (1) that under penalty of perjury that the information indicated in the account opening form for various products and

services, contained in this document, are true and accurate of my own personal knowledge. I undertake to notify the Bank of any

change of information indicated herein, (2) I understand that if I indicated my email address in this Account Opening Form, a

welcoming email will be sent to me within two (2) banking days once the account has been opened, which will include the T&Cs and

Tariff Guide. (3) that I have received by welcome email, read and understood, the Bank’s Terms and Conditions (T&Cs) and the Easy

Guide to Bank Services and Charges (the Tariff Guide) which I am also able to access at the Bank website www.hscb.com.ph, (4) that

I understood and agree to be bound by those terms and conditions that govern the availment and use of the accounts, products

and services that I have applied for. I hereby expressly, absolutely and unconditionally release, discharge and indemnify HSBC free

and harmless from any and all claims, liabilities, obligations, actions, proceedings, loss, damage, costs and expenses arising or in

connection with, directly or indirectly, HSBC acting upon these instructions, except in case of gross negligence on the part of HSBC.

13. ELECTRONIC STATEMENTS/ E-STATEMENTS




NA - Resident NA - Resident


1 Peso deposits funded by item 1 must have been used onshore to fund foreign direct investment/s and/or investments in eligible

portfolio instruments, which are registered with BSP or custodian bank, subject to the provisions of Chapter II (Foreign Investments)

hereof and related applicable appendices/ annexes, to allow full conversion to foreign exchange, otherwise, prior BSP approval shall

be required.

It is understood that the undersigned undertakes to provide or submit such documents or information as may be required by the

BIR or the Bank to support its non-resident status and that this permission is executed as a pre-requisite to the entitlement of the

undersigned to the withholding tax exemption privilege under existing tax rules.

For Non-Residents:

If I am now, or at any time subsequent to the opening of my Philippine currency account, become a non resident of the Philippines,

I affirm, acknowledge and agree: (1) that my Philippine currency account can only be funded by Philippine currency proceeds from

sources supported by documents as provided by requirements on non-resident owned accounts detailed in the relevant foreign

exchange regulations; (2) that each time I make or cause a deposit to be made, transfers and remits funds into my account, I deem

to make sufficient representations of the above; (3) that HSBC may refuse to accept any deposit, transfer or remittance of funds

into my account as a result of my failure to present the required documents and I agree not to hold HSBC liable for any loss,

damage, and/or expense which I may incur as a result of the Bank’s refusal. I authorize the Bank to inform and disclose my bank

account information, personal information and related details to the Commissioner of the Internal Revenue or equivalent officer of

the government or the Bureau of Internal Revenue and/or any staff or officers therein, that I am a non-resident of the Philippines

and to disclose or submit such information as may be necessary to establish such status to the exemption of my foreign currency

deposit account from Philippine withholding taxes.

Source of Funds Documents

1. Inward remittance of convertible foreign exchange 1

• Certificate of inward remittance (CIR) of foreign exchange and conversion to pesos using the

prescribed form under Appendix 1 of BSP Circular 794

2. Peso income of non-residents from, or peso sales proceeds

of, properties in the Philippines • Photocopy of contract / agreement of equivalent documents showing the source of pesos

3. Peso income of non-residents from, or peso sales proceeds

of, properties in the Philippines falling under Sections 34 and

35 of the Manual

• Photocopy of contract/ agreement or equivalent documents showing the source of pesos

• Photocopy of Bangko Sentral Registration Document

4. Onshore peso receipts of non-residents from residents for

services rendered by the former to the latter • Photocopy of contract / agreement or equivalent documents showing the source of pesos

5. Peso receipts of expatriates working in the Philippines for

less than one (1) year representing salary / allowance / other

benefits

Any of the following:

• Employment contract showing that a non-resident is an expatriate working in the

Philippines for less than one (1) year

• Certification of employer showing amount of compensation paid to the foreign national

during the validity of the contract

• Equivalent documents showing the source of pesos (e.g. pay slip) and expatriate status (e.g.

DOLE - issued work permit)

6. Peso funds of : (i) foreign students enrolled for at least one

semester in the Philippines; and (ii) non-resident Filipinos

Passport and School ID (for students)

• CIR of Foreign Exchange and conversion to pesos using the prescribed form under Appendix

10.1 of Circular 794 or if foreign exchange is hand-carried, proof of conversion to pesos

through AABs or AAB - forex corps or if with peso income, photocopy of contract /

agreement or equivalent documents showing the source of pesos

Minimum Documentation Requirements for Peso Deposit Accounts of Non-Residents






Specimen Signature 3 _______________________

SIGNING INSTRUCTION



APPLICANT 1



APPLICANT 2


Date

(dd-mmm-yyyy)

Date

(dd-mmm-yyyy)




RBWM 8Aug2017 0298 HSBC Account Opening Form · PDF fileRBWM_8Aug2017_0298 HSBC Account...

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