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Bills Payment Facility Application Form

The document is an application form for a bills payment facility. It requests information such as the corporate name, nature of business, purpose of the facility, authorized signatories, depository bank details, applicable payment channels, transaction details, subscriber reference codes, contact information, and required supporting documents. Signatures are needed from operations, finance, and systems departments to endorse the application for approval.

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Tracy Camille Cruz
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54 views1 page

Bills Payment Facility Application Form

The document is an application form for a bills payment facility. It requests information such as the corporate name, nature of business, purpose of the facility, authorized signatories, depository bank details, applicable payment channels, transaction details, subscriber reference codes, contact information, and required supporting documents. Signatures are needed from operations, finance, and systems departments to endorse the application for approval.

Uploaded by

Tracy Camille Cruz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

BILLS PAYMENT FACILITY APPLICATION FORM

Name of Biller
Corporate Name
Nature of Business
Purpose/use for BP Facility
Brief Description of Business
Corporate Address
Corporate TIN
CTC No./Date & Place Issued
Authorized Signatories for MOA
Name Position Competent Evidence of Identity
1.
2.
Depository Bank
Bank and Branch Name of Branch Head Landline/Mobile Phone E-mail Address

Short Name
Applicable Channel/s On Receipt
On Screen (One line, max of 10 characters)
 BancNetOnline (BOL)
Maximum of twenty-five (25) characters
 BancNet Mobile Banking (BMB)
Maximum of five (5) characters
 Member Banks’ Proprietary Channels*
________ Phone Banking
________ Internet Banking
________ Mobile Banking
*Subject to approval of member banks
Transaction Information Minimum Volume Fee per Transaction
To commence one (1) year from MOA notarization date Requirement
BOL N/A P10
BMB N/A P7
Programming Fee: PHP 56,000 to be charged to:
 Biller  Waived  Others (pls. specify)
_________________________
Subscriber Reference Code/Name (For BOL only)
 Subscriber Account No.  Credit Card No.
 Reference No.  Policy No.
 Customer No.  Student No.
 ATM Reference No.  Others (Pls. specify) ____________________________________
Contact Information
Department Operations Finance/Accounting Systems/Technical
Name
Office Landline
Mobile Phone
Fax
E-mail Address

Signature
__________________________ ____________________________ ______________________________
FOR BANCNET USE ONLY
Date Remarks Received by:

Endorsed by: Approved by:

Head, Business Development Aristeo P. Zafra, Jr.


Relationship Manager Division General Manager
Revised as of 2011-08
Please submit the following documents together with this application form. Incomplete application will not be processed.
1. Copy of SEC documents
2. Company Profile
3. Bank Certification from settlement account

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