Prescribed Authorization Form for Querying for the BSP Watchlist Files for Screening Applicants and Confirming Appointments of Directors and Officials

ho Sentral ng PiLi ibinas

MAYNILA, PILIPINAS

OFFICE OF THE DEPUTY GOVERNOR SUPERVISION AND EXAMINATION SECTOR

CIRCULAR LETTER NO. CL-2006- 0 4 6

To All Banks and Non-Bank Financial Institutions (NBFI)

Subject Prescribed Authorization Form for Querying the BSP Watchlist Files for Screening Applicants and Confirming

Appointments of Directors and Officials

Banks and NBFIs are hereby required to submit the prescribed authorization form to the appropriate supervision and examination department when querying the watchlist files of the BSP for the purpose of screening and hiring applicants and confirming elected directors and appointed officers. Attached Annex A is the prescribed form to be duly notarized and accomplished by each individual being queried by the bank/NBFI.

Securing the written authority of the concerned individuai/s is in compliance with Subsections X143.5(c) and 4143.Q5(c) of the Manual of Regulation for Banks and Manual of Regulation for NBFIs, respectively, as amended by Circular No. 421 dated 08 March 2004.

For compliance

Ox NESTOR A. ESPENILLA

Deputy Governor

December 2006

REPUBLIC OF THE PHILIPPINES ) MUNICIPALITY OF PROVINCE OF

AUthOriZation

do hereby authorize the following: after being swom in accordance with law,

a) (Name of Bank/NBFi)_ to conduct a background investigafion on myself which incude, among others, inquiring from the Watchlist Files of the Bangko Sentral ng Pilipinas; and

the above inquiry to b) The Bangko Sentral ng Pilipinas to disclose findings and/or results of (Name of_Bank/NBF1)

With the above authorization, i do hereby waive my right to the confidentiality of the information. that will be obtained as a result of the said inquiry.

appointment to the position of This authorization is issued in connection with my application for or (position) Ie (Name of

Regulations for Non-Bank Financial Institutions, respectively, as amended by. and 4143Q.5(c) of the Manual of Regulations for Banks and the Manuai of Circular No. 421 dated 08 March 2004. Bank/NBFI)] in compliance with the provisions of Subsections X143.5(c)

This authorization will only be used in connection with the above mentioned purpose or for such other legal purposes, which the law requires.

In Witness Whereof, I have hereunto set my hand this

(Signature Over Printed Name)

In the Community Tax Certificate Subscribed and Sworm to before me this having exhibited to me his day of

PANANALAPING MATATAG, BANSANG PANATAG

A. Mabini St., Malate 1004 Manila, Phtippines Trunkline (632) 524-70-11 URL:www.bsp.gov.ph e mait: [email protected]