Supplemental Form for Online Gaming Business
Account Name
____________________________________________________________________________________
Account Number
_________________________________________________
YES NO
1. Is your business classied under the online gaming industry?
If yes, please identify the Appropriate Government Agency (AGA) that issued the license:
c PAGCOR c CEZA c APECO c AFAB c Others, please specify:
___________________________________________________________
c c
2. Does your business provide service or have dealings/transactions with the online gaming industry?
If yes, please specify which category it belongs to:
c Customer Relations Provider
c Gaming Software/Platform Provider
c IT Support Provider
c Live Studio & Streaming Provider
c POGO Hub/Real Estate
c Special Class of BPO
c Strategic Support Provider
c c
3. Do you have related interest/relationship with any business or service provider under the online gaming industry?
If yes, please specify your position/relationship:
c 20% Stockholder
c 20% Ultimate Benecial Owner (UBO)
c Others, please specify:
______________________________________________________
c Primary Ocer (President, Treasurer, Secretary, etc.)
c Employee
c c
4. Do you process transaction related to the online gaming industry?
If yes, please provide information:
c Remittance facilitation between online gaming business and its clients
c Processing of pay-outs
c Others, please specify:
____________________________________________________________________________________________
c c
5. What are the names of the clients and counter-parties that you are servicing?
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
By signing, I undertake to advise the bank if I will be directly/indirectly exposed to the online gaming industry.
_________________________________________________________________________
Signature over Printed Name / Designation / Date Signed
For Business Account:
Name of Busin ess: __________________________________________________________________________________
Business Authorized Signatories
_______________________________________________________________
Signature over Printed Name
_______________________________________________________________
Designation / Date Signed
_______________________________________________________________
Signature over Printed Name
_______________________________________________________________
Designation / Date Signed
_______________________________________________________________
Signature over Printed Name
_______________________________________________________________
Designation / Date Signed
