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CUSTOMER INFORMATION
Last Name
First Name
Middle Name:
Birth Date
Place of Birth
Country of Birth
Gender
Male
Female
Citizenship
Landline No
Mobile Number
Tax Identification No: (TIN)
HOME ADDRESS
Residence Since
PERMANENT ADDRESS
FAX NO:
E-mail Address
BUSINESS PHONE (indicate local ext.)
Mother’s Maiden Name (First Name and Last Name)
Highest Educational Attainment
Post Graduate
College Degree
High School Graduate
Elementary Graduate
No Formal Schooling
Civil Status
Single
Married
Divorced
Separated
Widowed
Home Ownership
Owned
Mortgaged
Rented
Beneficiaries(Spouse/Children)
1
2
3
4
5
NAME OF SPOUSE (First Name and Last Name)
DATE OF BIRTH
COUNTRY OF BIRTH
FINANCIAL INFORMATION
Employment Status
Employed
Self-employed
Retired
Housewife
Student
Others
Indicate others
Source of Income/Funds
Local Source
Foreign Source
Salary
Business
Pension Maintenance
Regular
Interest/Commissions Beneficiary
OFW
Others
Indicate others
Foreign Source (indicate Country of Origin)
Employer or Business Name
Start Date with Present Employer of your Business
FX Transaction (if any) Inward Outward Amt:
Employer/Business Address
Nature of Employer’s/Your Business
Money Changer
Remittances
Trading/Distributor
Pawnshop
Services
Money Betting/Gaming
Non Profit Org
Profession
Others
Personal Monthly Income
Under Php10,000
Under Php10,000-Php 19,9999
Php 20,000-Php 49.999
Php 50,000-Php99,999
Php 10,000++
ACKNOWLEDGMENT/WAIVER
I hereby certify that all information given above is true and complete to my personal knowledge. I undertake to inform INSTYLE NEW GEM COSMETICS CORPORATION of any changes in any of the information contained herein. I further understand that SIC reserves the right to cancel my membership without prior notice if it proven that any of the above mentioned information is fraudulent.
The SIC will only use the information collected to inform you of updates and guide you to the process. I give my consent to the collection, process and use of my personal data in accordance with the Data Privacy Act of 2012 (Republic Act # 10173).
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Admin Office
#24 Atty Pat Senador Street corner Lincoln Street San Francisco Del Monte Quezon City
Contact Numbers
(02) 83767982
(02) 83767983
(globe)+63 917 864 2437
(smart) +63 918 944 7512
Plant Address
Blk 10, Lot 9, Sterling Business Park Marilao Bulacan
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