Please check applicable transaction (one form per transaction only)

Outward Cross-Border Remittance Domestic Interbank Funds Transfer For Bank use only.
Transfer funds to international banks abroad Transfer funds to other local banks REFERENCE NUMBER
FOR OUTWARD CROSS-BORDER REMITTANCE
Non-Trade RTGS (Real Time - PHP) PDDTS (Batch - USD)

Trade GSRT (Real Time - USD)

REMITTER’S/CUSTOMER’S INFORMATION
Complete Name (First Name, Middle Name, Last Name) / Company Name BPI Funding Account Number Contact Number

Complete Home / Business Address (Unit No. / Street / Town / City or Province / Zip Code) Email Address
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FOR INDIVIDUAL FOR CORPORATE / SOLE PROPIERTORSHIP / PARTNERSHIP
Citizenship Birthdate (mm/dd/yy) T.I.N. (Tax Identification Number)
Filipino Non-Filipino 01 / 06 /
T.I.N. (Tax Identification Number) / SSS or GSIS Number Place of Birth SEC / DTI Registration Number

Source of Funds (Salary, Business, Commission, Remittance, Pension etc.) SEC / Business Registration Date

Relationship to Beneficiary Place of Registration Is the company registered with BSP?

Yes No
TRANSACTION INFORMATION
Purpose of Remittance / Funds Transfer Currency
PHP USD Others
Amount in Words and Figures (based on selected currency)
( )
BENEFICIARY’S INFORMATION
Complete Name (First Name, Middle Name, Last Name) / Company Name Beneficiary’s Account Number Contact Number

Complete Address (Unit No. / Street / Town / City or Province / Zip Code)

Beneficiary’s Bank Name Beneficiary’s Bank Address / Branch

FOR OUTWARD CROSS-BORDER REMITTANCE TRANSACTIONS ONLY

Receiving Bank SWIFT Code / National Routing Code / Fed Wire Number International Bank Account Number (only applies to European Countries and some parts of the Middle East)

Intermediary Bank Name (if known) Other relevant information

Source of Foreign Exchange Currency Correspondent Bank Charges Paid By

BPI Other Banks / FOREX Corporation ✔ Others (ie. Moneychanger, Personal / Business Funds) Remitter Beneficiary
FOR TRADE TRANSACTIONS ONLY
Specify Goods Description Commodity Code Price per Unit

Vessel Name Port of Loading Transshipment

Yes Transshipment Ports: No
MODE OF PAYMENT FOR BANK USE ONLY

Direct Remittance Advance Payments Open Account DETAILS OF CHARGES FX CURRENT AMOUNT AMOUNT
If registered with BPI (BPI Reference No.:)
Face Amount

(Starts with 02026 for Head Office, 00407 for Binondo, or 00263 for Cebu)
Add Commission
If registered with another bank

Bank Name: Postage or Cable

Bank Reference No. (BRN):

Documentary Stamps
Type of Funding:
Self-Funded / FCDU Account Peso Funded CorrBank Charge
Debit My/Our SA/CA account as ff:
Principal Charges TOTAL CHARGES

CONSENT TO DISCLOSURE
I/We certify that the information provided in this Form are true, accurate and complete. I/We further warrant that, prior to submitting to the Bank any information (including
personal information of individuals related to me/us), I/we have obtained all necessary authorizations and consents as may be required by applicable confidentiality and
data privacy laws or agreement to enable the Bank to process such information and implement my/our remittance transactions.

By signing herein or by availing or continuing to avail of the products, services, facilities and channels of the Bank or of any member of the BPI Group of Companies, I/we
agree that all my/our information (including the personal information of individuals related to me/us) my/our transactions, business and credit relationships, accounts or
account information or records which are with the Bank, made available to the Bank or which are in the Bank's possession or updated from time to time, may be collected,
obtained, used, stored, consolidated, processed, profiled, benchmarked, shared to and disclosed, by and between the Bank and any member of the BPI Group of Companies,
their successors and assigns, and their respective authorized representatives, agents and service providers, for any or all the purposes described in the BPI Data Privacy
Statement published at www.bpi.com.ph and deemed incorporated by reference in this Form;

The foregoing constitutes my/our express consent under the applicable bank secrecy, confidentiality and data privacy laws of the Philippines and other jurisdictions,
including without limitation, the provisions of RA No. 1405 (The Law on Secrecy of Bank Deposits), RA No. 6426 (The Foreign Currency Deposit Act), RA No. 10173 (Data Privacy
Act of 2012), RA No. 8791 (General Banking Law) (collectively, the "Bank Secrecy and Privacy Laws") and I/we agree to hold the Bank, each member of the BPI Group of
Companies, their successors and assigns, and their respective directors, officers, employees, authorized representatives, agents and service providers, free and harmless from
any and all liabilities, claims, damages, suits, costs and expenses resulting from or in connection with the implementation of the purposes and authorities conferred by
me/us hereunder.

CUSTOMER'S SIGNATURE OVER PRINTED NAME CUSTOMER'S SIGNATURE OVER PRINTED NAME
TERMS AND CONDITIONS GOVERNING FUND TRANSFER / OUTWARD CROSS-BORDER REMITTANCE TRANSACTIONS
1. I/We acknowledge that the Bank may process my/our remittances in accordance with its policies and procedures and, for this purpose, it shall
have absolute discretion, on my/our behalf, to avail of the services of any correspondent banks and agents for data processing, collection and other
services related to the remittance transactions.
2. The Bank shall not be responsible nor liable for the acts or omissions of any other bank (including correspondents) or for mutilations, interruptions,
defaults, errors, non-transmission mishaps, accidents, or delays that might occur in the servicing of the transactions or for causes beyond the
control of the Bank or its correspondent banks or agents.
3. The Bank may send any message relative to the relevant remittance transactions in explicit language, code or cipher, through any telegraphic,
cable or radio establishment it deems appropriate and shall not be liable for errors, neglect or default that might be committed in the
transmission of the message, or in the misinterpretation thereof by the party/ies receiving it.
4. I/We acknowledge that, by coursing the remittance transaction through this Bank, additional service fees and bank charges may be imposed and
deducted from the proceeds by the correspondent banks as well as the receiving banks and I/we agree to these deductions. We likewise
understand that the service fees and bank charges arising from these transactions may vary depending on any of the following, but without
limitation, (i) remittance amount, (ii) remittance currency, (iii) purpose of remittance ie., whether trade or non-trade, (iv) conversion rate, and (v)
currency exchanges.
5. I/We understand that sanctions screening is required for all remittance transactions coursed through the Bank which may result in its cancellation
and/or delays in the execution of the remittance transaction. I/We likewise understand that the Bank is required to act in accordance with its
policies and procedures, the Bangko Sentral ng Pilipinas (BSP) rules and regulations and applicable laws including the laws of the Philippines and
those of various jurisdictions relating to the prevention of money laundering and/or the implementation of sanctions and I/we agree to comply
and be bound thereby.
6. Where applicable, I/we authorize the Bank to make currency conversions using the Bank's applicable prevailing exchange rate and subject to
applicable bank charges. I/We further acknowledge that each foreign currency conversion is processed at a rate which can vary from time to time.
In the event a remittance transaction is cancelled following a sanctions screening, any refund by the Bank will be processed using the prevailing
exchange rate on cancellation date net of costs incurred by it.
7. Other refunds, if requested, or cancellations for reasons other than due to a sanctions screening may be made at the discretion of this Bank
provided that the Bank shall have received confirmation of effective cancellation of the remittance, and/or all copies of drafts, if any, shall have
been surrendered; and, in case of funds already converted, refund may be made at the rate determined by the Bank net of costs incurred by it or
by its correspondent banks and agents.
8. The Bank reserves the right to request and obtain additional information from me/us from time to time to enable it to perform and/or complete
the remittance transactions failing which entitles the Bank to close my/our account or discontinue providing the service anytime without further
notice.
9. In view of the foregoing and by signing below, I/we agree to the following:
i. where applicable, declare under the penalties of perjury that my/our co-depositor(s) is/are still living.
ii. authorize the Bank to debit my/our account(s) for any Funds Transfer/Outward Cross-Border Remittance transaction fees and charges which
may be due and payable thereunder.
iii. fully comply with and abide by the Terms and Conditions Governing Funds Transfer/Outward Cross-Border Remittance and the Terms and
Conditions Governing the Bank's Products, Services, Facilities and Channels and the Consent to Disclosure Clause above-cited.
10. E-Signature. By signing this form or such other documents related to this form electronically, I/we agree that my/our electronic signature
shall constitute an original for all purposes and shall have the same legally binding force and effect as my/our handwritten signature. This form
signed electronically shall hereafter form part of the Client Authorization Letter (CAL) which I/we executed in favor of Bank of the Philippine
Islands.

CUSTOMER'S SIGNATURE OVER PRINTED NAME CUSTOMER'S SIGNATURE OVER PRINTED NAME

TELLER’S VALIDATION

FOR BANK USE ONLY

TBML/OFAC CHECKLIST
NDV DONE Remitter w/o Findings w/ Findings Beneficiary w/o Findings w/ Findings OK NOK
(please check) (please check) (please check) (please check) (please check) (please check) REMITTER
BENEFICIARY
NDB
COUNTRY
OFAC/PEP/WATCH LIST/
PORTS
OTHER SANCTIONS
VESSELS
ROGUE GALLERY
BANKS
OTHERS, please specify: COMMODITY
VERIFIED BY:
REMARKS

PROCESSED BY: SIGNATURE VERIFIED BY: APPROVED BY: DATE:

For any concerns, you may contact Bank of the Philippine Islands at (02) 889-10000 for Metro Manila; 1-800-188-89100 for domestic toll-free calls (available to PLDT subscribers); 63 + (02) 889-10000 for mobile phone
and international access; and International Toll-Free Numbers (refer to the Contact Us page at www.bpi.com.ph for details) or email [email protected]. Bank of the Philippine Islands is regulated by the Bangko
Sentral ng Pilipinas with email address: [email protected].

Deposits are insured by PDIC up to P500,000 per depositor.

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