AMD Form N-01b

Revised November 2011

BANGKO SENTRAL NG PILIPINAS

ASSET MANAGEMENT DEPARTMENT
Telephone Nos. 306-3422, 306-3423
Paste Passport Size
ID Photo
Here

BUYERS INFORMATION SHEET

(For CORPORATION/PARTNERSHIP)
(Please complete required information. If not applicable put N/A.)

For TCT No. _________________

Location
_________________

BUYERS DATA
Company Name:
Office Address:
Telephone No.

Fax No.:

Web Site:

Date Registered with SEC:

Nature of Business:

Length of Business:

Country of Incorporation:

% of Filipino Ownership:

Company TIN:

Authorized Person:

Position:

Telephone No.:

Government Issued ID
Issued By and No.:

E-mail Address:

Date and Place Issued:

MANAGEMENT
KEY OFFICERS

POSITION

Contact No.

Email Address:

EXISTING LOAN ACCOUNTS/OUTSTANDING CREDITS (Please use a separate sheet, if necessary)

Type of Loan:

Bank / Financial Institution / Creditor & Address:

Original Amount:

Monthly Payment:

OTHER ASSETS

Outstanding Balance:

CREDIT HISTORY

Maturity Date:

(Please use a separate sheet, if necessary)

(Please use a separate sheet, if necessary)

Type of Property/Investment
Does the corporation/partnership have an existing loan with other banks or other financial institutions?
If yes, please give details and submit proof of last amortization payment ___________________

Location/Description
Estimated Value
Is the abovementioned property used as a
security for a loan?
Yes
No
If yes, please give details _______________

Yes
No

Are there cases, past or pending filed against the corporation/partnership involving non-payment of obligations or mishandling or
issuance of bouncing checks?
Yes
No If yes, please state the nature and status of the case _____________________

CERTIFICATION
I hereby certify that the above statements are true, correct and complete to the best of my knowledge and belief and hereby agree that any misrepresentation or nondisclosure of a material fact shall be a ground for the disapproval of my offer. I agree to notify the BSP of any material change in the data stated herein. I likewise authorize the BSP
to undertake whatever investigation or verification to check the validity or information contained herein. Lastly, I understand that it may be a criminal offense punishable by fine or
imprisonment, or both, to knowingly make untruthful statements or related falsehoods upon any material matter concerning any of the above statements under the criminal laws
of the Philippines.
____________________________
Date Signed

_____________________________
Signature Over Printed Name

____________________________
Date Signed

_____________________________
Signature Over Printed Name

DOCUMENTARY REQUIREMENTS
Republic of the Philippines)
City of Manila
) S.S.
SUBSCRIBED AND SWORN TO BEFORE ME THIS ______ DAY OF _______, 2011 AT ____________ BY
___________________________
(Name of Buyer)

Doc No. _____________

Page No. ____________
Book No. ____________
Series No. ___________

__________________
Com. Tax Cert. No.

___________________
Date and Place of Issue

Put a mark on the items submitted:

( ) SEC Registration, Articles of Incorporation/Partnership & By-Laws
(photocopy)
( ) Business Permit (photocopy)
( ) Secretarys Certificate on Authority to Purchase (original copy)
( ) Secretarys Certificate on Authorized Signatory (original copy)
( ) Government Issued ID & BIR TIN of Authorized Signatory (photocopy)
( ) Income/Corporate Tax return (photocopy)
( ) Audited Financial Statements for the last two years (photocopy)
( ) For non-resident alien Affidavit on Total Landholdings