Application Form
Please use separate form for each type of transaction.
Branch Date April 5, 2024
PHILAM TOWER VALERO
Manager’s / Gift Check Sale / Purchase Foreign Currency Demand Draft Others (please specify) SOA December 1, 2023 to March 31, 2024
Customer Information
Name Account Number
CHERE MADELEINE BAUTISTA REYES
First Name Middle Name Last Name 001680439322
Present Address
Unit 18HI Tower 1 Forbeswood Parklane Rizal Drive BGC, Taguig City, Philippines
Permanent Address
Unit 18HI Tower 1 Forbeswood Parklane Rizal Drive BGC, Taguig City, Philippines
Contact Numbers ID Presented
0917-5369293
Payee Information (For Manager’s / Gift Check and Demand Draft Application Only.)
Payee
Address
Amount (in words) (in figures)
( )
Currency Purpose/Reason
Mode of Payment
Cash Check Debit from Account / Credit to Account I/We have read and hereby authorize the Bank to carry out this instruction and agree to be
governed by your terms and conditions printed below. Furthermore, I/We authorize the Bank
FX Rate to debit the above account for the payment of applicable fees and charges to implement
my/our request.
Amount of Request / Converted Amount
Service Charge
Customer’s Signature
Documentary Stamps
Total
Acknowledgment Receipt of Forex Transaction
Additional Information for Non-BDO Account Holders
Birthdate Birth Place Nationality Mother’s Full Maiden Name
Nature of Work Source of Funds Tax ID No. SSS or GSIS No.
Terms and Conditions
On Manager's / Gift Check c. Cancellation of Unnegotiated Manager's / Gift Check
a. Application The purchaser confirms that the BDO Manager's / Gift Check remains unnegotiated, and
A “Stop Payment Order “may not be instituted over a Manager's/ Gift Check once the as such wish to have the check cancelled by the Bank. The purchaser agrees to
Applicant has taken delivery thereof. However, the Bank may, in its sole discretion, indemnify the bank for any actual and consequential damages/losses which the bank
entertain and implement a “Stop Payment Order” under the following conditions: may incur or suff�er by the reason of the cancellation of the aforesaid Manager's / Gift
(1) The Manager's / Gift Check shall have been lost, stolen or believed to be destroyed; Check.
(2) The Applicant shall deliver to the Bank d. Lost Manager's / Gift Check
(a) An affidavit attesting to the loss, theft, robbery or destruction of Manager’s / Gift In the event of a lost/stolen or destroyed Manager's / Gift Check, the Bank reserves the
Check; right to impose any conditions relative to the refund/replacement of the said check.
(b) A Stop Payment Order form duly accomplished and signed; On Demand Draft
(c) An indemnity bond with a life of one (1) year for an amount equal to Two a. Application
Hundred Percent (200%) of the face amount of the Manager's / Gift Check said
to be lost, stolen or destroyed, conditioned to indemnify the Bank for any and all The Draft is issued with the distinct understanding that it will be forwarded abroad
liabilities it may incur as a result of or by reason of having dishonored a immediately for presentation to the drawee. The Bank will not be responsible should the
Manager's / Gift Check alleged to have been lost, or destroyed. draft be dishonored as a result of delay in presentation or any other reason beyond its
control.
b. Manager’s Check with “Cash or Bearer” as Payee
The Applicant acknowledges that the proceeds of a Manager’s Check payable to b. Lost Demand Draft
“BEARER” or “CASH” or other words of equivalent meaning may be paid to any In the event of a lost/stolen or destroyed Demand Draft, the Bank reserves the right to
possessor thereof who presents it for payment. He/she agrees and undertakes to assume impose any conditions relative to the refund/ replacement of the said check.
all the risks involved in the event it is lost or stolen and to hold the Bank free and harmless On Purchase / Sale of Foreign Currency Notes
from any liability whatsoever for payment made to any possessor who presents the The Applicant holds himself fully and unconditionally responsible and agrees to reimburse the
Manager’s Check to the Bank. Furthermore, he/she agrees and confirms that he/she Bank on demand the proceeds of purchase / sale of foreign currency notes in the event of
cannot countermand payment of the Manager’s Check in any cases, particularly when it error or irregularity.
is already in the possession of another person.
For Bank’s Use Only
Verified/Processed By Approved By Date
