Printable Customer Information Form PDF Details

A printable customer information form is an important document to have on hand for your business. This form allows you to collect the necessary information from customers, such as name, address, and contact information. Having this information in a central location makes it easy to keep track of your customers and stay in touch with them. You can also use this form to record any transactions that take place between you and the customer. For example, if you are providing services or selling products to the customer, you can note those details on the form. having a printable customer informationform is a great way to make sure that your business runs smoothly and efficiently. You can find free templates for printable customer information forms online.

This quick guide will let you determine how much time it will take you to complete printable customer information form, how many pages it's got, and a few other specific specifics of the form.

QuestionAnswer
Form NamePrintable Customer Information Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesnumber fill in, pdf filler contact, FormsPal com phone number, FormsPal customer service phone number

Form Preview Example

CITISECONLINE.COM, INC.

2401-B East Tower, Philippine Stock Exchange Centre

Exchange Road, Ortigas Center, Pasig City, 1605 Philippines

Customer Service Hotline (632) 6-333-777

Fax Number (632) 636-3512

CUSTOMER ACCOUNT INFORMATION FORM

(Form must be completely filled up)

 

 

 

 

 

 

 

 

 

ACCOUNT NUMBER:

_________________

√ Affix your signature where required

 

 

 

 

 

 

 

 

 

 

 

 

(to be filled by CitisecOnline)

 

 

 

 

 

 

 

 

 

 

 

PLEASE WRITE CLEARLY IN BLOCK CHARACTERS

 

 

 

 

 

 

 

 

Individual

 

 

 

Joint Or

 

 

Joint And

 

 

Others

__________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION ABOUT THE PRIMARY ACCOUNT HOLDER

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

 

 

First

 

 

 

 

 

 

Middle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender

 

 

 

 

 

 

 

 

Civil Status

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

 

 

 

Female

 

 

 

 

Single

 

 

Married

 

Widowed

 

Separated

Name of Spouse (if applicable)

 

 

Number of Dependents (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (month/day/year)

 

 

Place of Birth (town/province/city)

 

 

 

 

Citizenship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filipino

 

 

Other ______________________

Tel No/ Mobile No (including country code and area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email Address

 

 

 

 

 

 

 

 

Facsimile No (Including country and area code)

 

 

Residential Address (no, street, town/district, city/province, postal/zip code, country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Educational Background

 

 

 

 

 

 

 

 

Employment Status

 

 

 

 

 

 

 

 

 

 

Primary

 

 

 

Secondary

 

 

Tertiary

 

 

 

Employed

 

 

Self-Employed

 

Unemployed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Post Graduate

 

 

 

Other _________________

 

 

 

Retired

 

 

Other _________________

Tax Identification Number

 

 

 

 

 

 

 

 

SSS or GSIS Identification Number

 

 

 

 

Name of Employer/Name of Business (if Owned)

 

 

Nature of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Tel No/Fax No (+ country code and area code)

 

 

Years with employer/Years of Business (if Owned)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer Address / Business Address (no, street, building,town/district, city/province, postal/zip code, country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

page 1 of 3

FINANCIAL AND INVESTMENT PROFILE

Liquid Net Worth (in Php)

 

 

 

Total Net Worth (in Php)

 

 

 

 

 

Annual Income (in Php)

 

 

 

 

 

 

< 500,000

 

< 1 Million

 

 

 

 

< 500,000

 

 

 

< 1 Million

 

 

 

< 250,000

 

< 500,000

 

 

 

 

 

< 5 Million

 

< 10 Million

 

 

 

 

< 5 Million

 

 

 

< 10 Million

 

 

 

< 750,000

 

< 1 Million

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Over 10 Million

 

 

 

 

 

 

 

Over 10 Million

 

 

 

 

 

 

 

 

 

 

 

 

Over 1 Million

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Source of Income

Approximate Amount of Capital Available for

Risk Tolerance

 

 

 

 

 

 

 

Salary

 

Retirement

Investment (in Php)

 

 

 

 

 

 

 

 

 

 

 

 

 

Aggressive

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Investment

 

Others

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Moderate

 

 

 

Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Conservative

Investment Objectives

 

 

 

Investment Experience

 

 

 

 

 

Investment Knowledge

 

 

 

 

List 1 to 4 in order of priority

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Capital Preservation

 

 

 

 

None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

None

 

 

 

 

 

 

 

Long Term Investment

 

 

 

 

Limited

 

 

 

 

 

 

 

 

 

Limited

 

 

 

 

 

 

 

Growth

 

 

 

 

 

 

 

Good

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Good

 

 

 

 

 

 

 

Speculation

 

 

 

 

 

 

 

Extensive

 

 

 

 

 

 

 

 

 

Extensive

 

 

 

 

DISCLOSURES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you a corporate officer or director, or do you own 10% or more of a PSE listed or publicly held Company?

 

 

 

 

 

 

 

 

 

No

 

 

Yes (specify name) ________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you an officer or employee of another Borker/Dealer?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

Yes (specify broker and present consent letter by employer) ______________________

Do you have an account(s) with other stockbrokerage firms or mutual fund companies?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

 

 

Yes (specify name) ________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INFORMATION ABOUT THE SECOND ACCOUNT HOLDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

 

 

 

 

 

 

 

 

 

 

 

 

First

 

 

 

 

 

 

 

 

 

 

 

Middle

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender

 

 

 

 

 

 

 

 

 

Civil Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

 

 

Female

 

 

 

 

 

 

 

 

 

Single

 

 

Married

 

 

 

Widowed

 

Separated

Name of Spouse (if applicable)

 

 

 

 

 

 

Number of Dependents (if applicable)

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (month/day/year)

 

 

 

 

 

 

Place of Birth (town/province/city)

 

 

 

 

 

 

 

 

 

 

 

Citizenship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filipino

 

 

Other __________________

Tel No/ Mobile No (+ country code and area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email Address

 

 

 

 

 

 

 

 

 

Facsimile No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residential Address (no, street, town/district, city/province, postal/zip code, country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Educational Background

 

 

 

 

 

 

 

 

 

Employment Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary

 

 

Secondary

 

 

 

Tertiary

 

 

 

Employed

 

 

 

Self-Employed

 

Unemployed

 

 

 

Post Graduate

 

 

Other _____________

 

 

 

Retired

 

 

 

Other _________________

Tax Identification Number

 

 

 

 

 

 

 

 

 

SSS or GSIS Identification Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Employer/Name of Business (If Owned)

Nature of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Tel No/Fax No (+ country code and area code)

Years with Employer /Years of Business (If Owned)

 

 

 

 

Employer Address/ Business Address (no, street, building,town/district, city/province, postal/zip code, country)

page 2 of 3

FINANCIAL AND INVESTMENT PROFILE

Liquid Net Worth (in Php)

Total Net Worth (in Php)

 

Annual Income (in Php)

 

< 500,000

< 1 Million

< 500,000

< 1 Million

< 250,000

< 500,000

< 5 Million

< 10 Million

< 5 Million

< 10 Million

< 750,000

< 1 Million

Over 10 Million

Over 10 Million

Over 1 Million

Primary Source of Income

Approximate Amount of Capital Available for

Risk Tolerance

 

 

 

Salary

 

 

Retirement

Investment (in Php)

 

 

 

Aggressive

 

 

 

 

 

 

 

 

 

 

 

 

Investment

 

Others

 

 

 

 

 

 

 

 

Moderate

 

 

Business

 

 

 

 

 

 

 

 

 

 

Conservative

Investment Objectives

 

 

 

Investment Experience

Investment Knowledge

List 1 to 4 in order of priority

 

 

 

 

 

 

 

 

 

 

 

 

 

Capital Preservation

 

 

None

 

 

None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long Term Investment

 

 

Limited

 

 

 

Limited

 

 

Growth

 

 

 

 

Good

 

 

Good

 

 

Speculation

 

 

 

 

Extensive

 

 

Extensive

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISCLOSURES

 

 

 

 

 

 

 

 

 

 

 

Are you a corporate officer or director, or do you own 10% or more of a PSE listed or publicly held Company?

 

 

 

No

 

 

Yes (specify name) ________________________________________

Are you an officer or employee of another Borker/Dealer?

 

 

 

 

 

 

 

No

 

 

Yes (specify broker and present consent letter by employer) ______________________

 

 

 

 

 

 

 

 

 

Do you have an account(s) with other stockbrokerage firms or mutual fund companies?

 

 

 

 

 

 

 

No

 

 

Yes (specify name) ________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MAILING AND COMMUNICATION INSTRUCTIONS

 

 

 

 

Confirmation of invoices and other notices will be sent thru Email/Electronic Delivery

 

 

 

 

Email Address

 

 

 

 

 

Facsimile No (+country and area code)

CUSTOMER BANK ACCOUNT DETAILS

 

 

 

 

Bank Account Name

 

 

 

 

 

Bank Account Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bank Name and Branch Address (pls indicate complete name and address)

 

 

 

 

APPLICATIONREQUIREMENTS AND INSTRUCTIONS

* Minimum cash/check deposit of P25,000 made payable to CitisecOnline.com Inc.

* Photocopy of at least two (2) acceptable indentification (please present original for verification)

- Passport, Phil. Drivers Liscence, SSS ID, Credit Card (w/Pic), Birth Certificate, Company ID (w/Pic) or other government accepted IDs

For Non-Filipinos residing in the Philippines, include a photocopy of current visa, alien certificate of registratiion (ACR) and proof of government permission to engage in business / employment; validity period of work permit must be at least one year from its date of issue. * Latest copy of any of the following:

- Public Utility Bill, Credit Card Statement or Bank Statement

* Specimen Signature Cards (2)

* Online Securities Trading Agreement (OSTA) * Additional Requirements for non Residents:

- Proof of Income Duly Certified by Employer

- Identification Documents authenticated by Philippine Embassy or Consulate

I / we confirm that the information given by me/us is true and correct. I/we authorize CitisecOnline to verify the same from whatever sources it may consider appropriate. I/we understand that any misrepresentation I/we make on the submitted documents is sufficient grounds for legal action against me/us and the rejection or my/our application. I/we understand that should my/our application be denied, CitisecOnline has no obligation on its part to furnish the reason for such rejection.

Signature(s)

√

Primary Account Holder

Date

Secondary Account Holder

Date

 

 

 

 

 

(For CITISECONLINE'S use only)

 

 

 

 

Referror/Salesman

 

Processed by

 

Approved by

 

 

 

 

 

page 3 of 3

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