Nature of Business:

Company Website:

Contact Person:

Last Name First Name Middle Name Birthdate(MM/DD/YY)

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[ _ ] COMPANY IS MBTC CLIENT* [ _ ] OTHER MBTC RELATIONSHIP COMPANY ADDRESS ON RECORD: PHONE NUMBER ON RECORD:

*applicable to MBTC clients only

Position / Level

Branch Head/ BOO /Unit Head Name SIGNATUREApproved/ Printed Date: March 2015

Gross Annual Salary

COMPANY INFORMATION

(PLEASE ATTACH A PHOTOCOPY OF THE COMPANY ID WITH SIGNATURE OF THE SIGNATORY)

Signature Over Printed Name/Date

[ _ ] PAYROLL CLIENT

Head of Branch or Unit:

BH or BOO Signature:

FOR METROBANK PERSONNEL ONLYREFERRER DETAILS:

Branch Code:

Hiring Date(MM/DD/YY)

Referrer's Card Details:

Company Name:

Company Address:

HR Manager / Designated Officer:

Phone:

If Satellite/Branch (please indicate head office):

" This is to certify that the company details indicated is true and correct and that I have validated and confirmed that the person who signed this template is an Authorized Signatory of this Company."

CERTIFICATION

[ _ ] COMPANY IS NOT A MBTC CLIENT

Referrer's Name:

Branch or Unit Name:

COMPANY DETAILS: (Mark with "x" all that applies)

CBG/BLG/TBG Head Signature:

MCC USE ONLY

Program Code: ____________________ Sub Program Code: _________________ Agent Code: ______________________ Company Code: ___________________ Total # of Turn Ins: _________________ 3rd Line Embossing: YES NO

Designation/Position

Company Certification and Employee List FormGOV-PUB PROGRAMGAP HRP

This is to certify that the information shown in the above employee list of bona-fide regular employees of <__________________> is true and correct. The Company, thru this Form, signifies intent to avail of the Metrobank Card Corporation (MCC) Human Resource Package (HRP), Government Offices and Public Schools Program (GOV-PUB) or Group Application Program (G.A.P.) and unilaterally applies for an MCC credit card on behalf of its employees. It is understood that MCC reserves the right to decline card issuance to any of the above listed employees that may be deemed unqualified without need for explanation and that the Company shall continuously inform MCC in writing any addition or resignation / termination / retirement of any employee provided in the list at least 5 working days before date of effectivity. It is further certified that the above listed employee information is the same as what appears in the respective 201 files. Moreover, pursuant to BSP Circular No. 706, which permits reliance on a third party for purposes of the customer identification process, the procurement of customer identification, gathering of minimum information and face-to-face contact, the Company hereby further certifies that it has conducted the necessary identification (both documentary and face-to-face) and background verification for the named employees and the Company obtains, and keeps in its custody, all the minimum information and/or identification documents required to be obtained from employees which upon request, may be furnished by the Company to MCC in accordance with BSP Circular 706. (“Updated Anti-Money Laundering Rules and Regulations”)