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UCPB Client Information Update Sheet CIUS
UCPB Client Information Update Sheet CIUS
This form is an update to the Customer Information Sheet (CIS) which you filled out during account opening. If there
are other changes not covered in this form, you will be required to fill out the complete CIS. Please submit this
form together with a 1 valid photo-bearing IDs issued by an official authority with signature, identification number
or date of birth, to your UCPB Branch. Please be advised that your request can only be processed upon receipt of a
clear photocopy or scanned copy of your valid ID and supporting documents. A list of valid IDs is available at the
back of this form.
Date (mm-dd-yyyy) CIF No.(To be filled out by Bank)
I. PERSONAL INFORMATION
Last Name First Name Complete Middle Name No Middle Name Title After Name
Jr. Sr. Others __________
Citizenship
Filipino Others __________________________________________________________________________________________
Resident Resident Alien Alien Certificate Registration (ACR) No. _____________________________________________
Non-Resident Non-Resident Alien (ACR is also required for NRAs staying more than 59 days)
Dual Citizen _______________ ACR No. ______________________________________________________________________________________
Civil Status (Change of status will need supporting documents)
Single Married Widower/ Widow Divorced/ Annulled Legally Separated
Highest Educational Attainment
Elementary High School College Masters/ PhD No Formal Schooling
Tax Identification Number Without TIN Reason for no TIN
Homemaker Student Non-Filer
SSS GSIS UMID AFPMBAI/AFP-RSBS Without SSS/GSIS/UMID/AFPMBAI/ AFPMBAI/AFP-RSBS Reason for no SSS/ GSIS/ UMID/ AFP No.
Student Non-member
Name of Spouse Spouses Date of Birth Name of Beneficiary Beneficiarys Date of Birth
FATCA STATUS
Confirm your FATCA status and indicate the date the IRS Form is signed.
DATE OF IRS
US INDICIA FORM YES NO IF YES, PROVIDE THE FOLLOWING:
1. US Citizenship 1. IRS Form W-9 and
2. US Resident Green Card 2. US Passport or other Identification
3. Signed Confirmation, Consent and Waiver
3. US Resident Residing in the US for 183 days 1. IRS Form W-9 and
or more 2. US or Non-US Passport or other Identification
3. Signed Confirmation, Consent and Waiver
If any of your answers to numbers 1 to 3 is YES, do not answer numbers 4 to 8.
4. US Place of Birth (State) Any of the following:
1. IRS Form W-9 and
2. Copy of Individuals Certificate of Loss of Nationality of the
US (passport, drivers license, etc.) and
3. Identification Documents
3.1 US Identification Documents (passport, drivers
license, etc.) or
3.2 Non-US Identification Documents (passport, drivers
license, etc.) and
written explanation of your renunciation of US
citizenship or the reason you did not obtain US
citizenship at birth
5. US Resident/ Mailing Address (Residence, 1. IRS Form W-8BEN and
correspondence or P.O. Box) 2. Non-US Identification Document (Tax Certificate or ID
issued by the government or an Identification Document
6. US Telephone Number based on KYC as approved by the IRS in the Q1 system)
7. Standing instruction to transfer funds to an 3. Signed Confirmation, Consent and Waiver
account maintained in the US
8. Power of Attorney or signatory authority Any of the following:
granted to a person with a US address, or in 1. IRS Form W-8BEN or
care of or hold mail address 2. Non-US Identification Document (Tax Certificate or ID
issued by the government or an Identification Document
based on KYC as approved by the IRS in the Q1 system)
IRS Form W-9 is the Request for Taxpayer Identification and Certification. This is used by the US Person.
IRS Form W-8BEN is the Certificate of Foreign Status and Beneficial Owner for US Tax Withholding and Reporting. This is used by Non-US Person.
VII. DOCUMENTARY REQUIREMENTS
IDENTIFICATION CARDS PRESENTED AND ISSUE DETAILS
Submit any one of the following valid photo-bearing IDs with signature issued by an official authority
TYPE OF ID ID NO. TYPE OF ID ID NO. TYPE OF ID ID NO.
Company ID Drivers License Passport
UMID GSIS e-Card/ SSS Card TIN ID
PhilHealth ID/ PHIC ID Senior Citizen ID Sudent ID
Postal or Voters ID GOCC ID (AFP ID, HDMF ID, etc.) PRC/ IBP ID
Barangay Certification NBI or Police Clearance PWD/ NCWDP
DSWD Certification OFW/OWWA ID/Seamans Book IBP ID
For Resident Alien For Sole Proprietor
ACR SRRV SRIV SBMA/CDC DTI Certificate of Registraton
ACCEPTABLE SUPPORTING DOCUMENTS
Submit any one of the following supporting documents
TYPE OF REQUEST SUPPORTING DOCUMENTS TYPE OF REQUEST SUPPORTING DOCUMENTS
Name Change/ Birth Certificate Nature of Work/ Company ID
Name Correction Marriage Certificate (If Single to Married) Name of Employer Certificate of Employment issued in the last 60 days
Passport or any valid government-issued ID Endorsement from Human Resources
Certificate/Court order for the annulment/ divorce Business Registration (If self-employed)
Change of Present/ Proof of Billing Source of Funds Certificate of Employment
Permanent Address Government-issued ID with address Latest payslip
Citizenship Passport Employment Contract
Any valid government ID reflecting Clients Latest ITR and/or AFS, W2
citizenship DTI Registration/ Business Registration
VIII. CERTIFICATION
By signing below, I hereby certify and attest to the fact that all information represented and given by me are true and
correct. I shall promptly communicate to the Bank any changes in the foregoing information. I hereby authorize the
Bank to verify and investigate any and all information given by me, as the Bank may deem appropriate.
I further certify that I have read and understood the Terms and Conditions on Deposit Product and Services and hereby
accept them. I further acknowledge receipt of a copy of said Terms and Conditions.
______________________________________ ______________________________________
Signature of Client over Printed Name Date