RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
Do you have a relationship with HSBC outside the Philippines?
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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)
Country: PHL Others ________________
______________________________________
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,
Bldg./House No., Street Subd./Brgy./District, Town, City/Province)
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:
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:
Legally Separated/ Divorced Living Together
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 ________________
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 1 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
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Postal Code: ____________ Postal Code: ____________
Country: PHL Others ________________ Country: PHL Others ________________
Length of Stay: __________ years _________ months Length of Stay: __________ years _________ months
Postal Code: ____________
Length of Stay: __________ years _________ months
Postal Code: ____________
Length of Stay: __________ years _________ months
Length of Stay: __________ years _________ months
Country: PHL Others ________________
__________ years _________ months
Country: PHL Others ________________ Country: PHL Others ________________
PREVIOUS RESIDENTIAL ADDRESS (Room No./Office Name,
Bldg./House No., Street Subd./Brgy./District, Town, City/Province)
*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)
Country: PHL Others ________________
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
Country: PHL Others ________________
Postal Code: ____________Postal Code: ____________
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
Country: PHL Others ________________
PREVIOUS RESIDENTIAL ADDRESS (Room No./Office Name,
Bldg./House No., Street Subd./Brgy./District, Town, City/Province)
*State address history for the past 3 years, if staying at present
address for less than 3 years.
Postal Code: ____________ Postal Code: ____________
Length of Stay:
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 2 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
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D D - M M M - Y Y Y Y D D - M M M - Y Y Y Y
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Residence Phone 1 Residence Phone 1
Residence Phone 2 Residence Phone 2
Office Phone No. Office Phone No.
Father's Date of
Birth(dd-mmm-yyyy)
Father's Date of
Birth(dd-mmm-yyyy)
Mobile No. Mobile No.
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
Guardian's Date
of Birth(dd-mmm-yyyy)
Guardian's Date
of Birth(dd-mmm-yyyy)
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
If below 18 years old, please supplement the following details:
SSS or GSIS No.
2. CONTACT DETAILS
APPLICANT 1
APPLICANT 2
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
Email address:
3. DOCUMENTARY DETAILS
APPLICANT 2Government ID type: ID number:
Tax Identification No.
Country (ies) of Tax Residence:
Email address:
Last
PERSONAL DETAILS continued
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.
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 3 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
Employee Business Owner *Key Controller
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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
Postal Code: ____________
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)
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
Country: PHL Others ________________
Postal Code: ____________
Name of Previous Employer
APPLICANT 1
Country: PHL Others ________________
Employment
Start Date(dd-mmm-yyyy)
Employment
Start Date(dd-mmm-yyyy)
Employment Type
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)________
Employer's/Business Name:
Nature of Business:
APPLICANT 2
4. EMPLOYMENT DETAILS
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
*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:
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)
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 4 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
Expected Total Relationship Balance: Expected Total Relationship Balance:
APPLICANT 2
PHP
5. CUSTOMER PROFILE
APPLICANT 1
Others (please specify):
Others (please specify):
Retirement/Pension Inheritance
PHP ____________/annum PHP ____________/annum
Contribution/Allowance from Winnings from Lottery/
family members/individuals Betting/Casino
PHP ____________ /annum PHP ____________/annum
Total Net Worth
Active Wealth/Investments (trading of
securities/currencies, franchises, inventions,
royalties, patents, real estate, jewelry)
Practice of Profession Employment Income
PHP ____________ /annum PHP ____________/annum
Business Income Sale of Property/Business
PHP ____________ /annum PHP ____________/annum
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
PHP ____________ /annum PHP ____________/annum
Business Income Sale of Property/Business
PHP ____________ /annum PHP ____________/annum
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
Value of Assets/Wealth/Investments
(trading of securities/ currencies,
franchises, inventions, royalties, patents,
real estate, jewelry)
Others (please specify):
Value of Assets/Wealth/Investments
(trading of securities/ currencies,
franchises, inventions, royalties, patents,
real estate, jewelry)
PHP
PHP
Others (please specify):
Retirement/Pension Inheritance
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 ____________
Retirement/Pension Inheritance
PHP ____________ PHP ____________
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
Contribution/Allowance from Winnings from Lottery/
family members/individuals Betting/Casino
PHP ____________ PHP ____________
Earnings/Savings from Sale of Property/
Business Income Business
PHP ____________ PHP ____________
Retirement/Pension Inheritance
PHP ____________ PHP ____________
Contribution/Allowance from Winnings from Lottery/
family members/individuals Betting/Casino
PHP ____________ /annum PHP ____________ /annum
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 5 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
Which country (ies) do the funds originate from?
Transaction Amount Number of
Transactions
Remarks (e.g. child student fees)
International
(Specify countries)
Non-Cash
APPLICANT 2
Cash Non-Cash
Local
(within the Philippines)
Local
(within the Philippines)
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
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)
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
(within the Philippines)
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
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
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 6 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
Type of Relationship (e.g. Credit Card, Housing Loan, etc.)
9. MAILING/CORRESPONDENCE ADDRESS
APPLICANT 2
APPLICANT 1 APPLICANT 2
APPLICANT 1
Bank NameType of Relationship
(e.g. Credit Card, Housing Loan, etc.)
Bank Relationships Other than HSBC:
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
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:
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.
APPLICANT 2
Will you have any Connected Parties? (Power Of Attorney,
Supplementary Card Holder, Safety Depost Box Deputy, *Contributor)
Relationship:
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
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.
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 7 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
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
AGREEMENT TO BANK TERMS AND CONDITIONS
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:
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 2 NA - Resident
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 NA - Resident
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
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 8 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
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.
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.
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
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 9 of 10
RBWM_8Aug2017_0297 HSBC Account Opening FormCUSTOMER INFORMATION FORM
D D - M M M - Y Y Y Y D D - M M M - Y Y Y YDate
(dd-mmm-yyyy)
Date
(dd-mmm-yyyy)
Specimen Signature 3 _______________________
APPLICANT 2
Specimen Signature 1 _______________________
Specimen Signature 2 _______________________
APPLICANT 1
Specimen Signature 1 _______________________
Specimen Signature 2 _______________________
Specimen Signature 3 _______________________
SIGNING INSTRUCTION
INTERNAL - Issued by The Hongkong and Shanghai Banking Corportion Limited
Member of the Philippine Deposit Insurance Corporation
Maximum Deposit Insurance for Each Depositor Php500,000 Page 10 of 10
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