TitleLast NameFirst NameOther Names

Middle Names

Date of Birth / / CitizenshipD D M M Y Y Y Y

F. CONTACT INFORMATION

Home Phone Fax PhoneMobile Phone Work PhoneEmail Address

Father's NameMother's NameMother's Maiden Name

Apt#/Street # & NameDistrict / Town / CityParish / County / StatePostal Code / Zip Code Country

Credit Card / Bank Statement Cable Bill Utility Bill Other (Please Specify)______________________________________________________________________________

D. previous ADDRESS

Apt#/Street # & NameDistrict / Town / CityParish / County / StatePostal Code / Zip Code Country

C. MAILING ADDRESS

Apt#/Street # & NameDistrict / Town / CityParish / County / StatePostal Code / Zip Code Country

G. NEXT OF KIN INFORMATION

Title

Last NameFirst NameOther Names

Middle Names

Apt#/Street # & NameDistrict / Town / CityParish / County / StatePostal Code / Zip Code CountryRelationship Telepone #:

Select ID Type

ID Number

Date of Issue (DD/MM/YYYY) / / Select Taxpayer ID Type

Expiry Date (DD/MM/YYYY) / / Taxpayer ID #

Country of Issue

MEMBER INFORMATION FORM

CONTACT INFORMATION

NEXT OF KIN / CONTACT PERSON INFORMATION

IDENTIFICATION INFORMATION

MEMBER NAME

HOME ADDRESS

MAILING ADDRESS (If different from Home Address)

PREVIOUS ADDRESS

PROOF OF ADDRESS (documents should be less than 6 months old)

FAMILY NAMES

Alias

Alias

Maiden NameGender Male Female Nationality

Mr Mrs Miss Ms Other Please Specify __________________________________________________________________________

Marital Status Unmarried Married Divorced Separated Widowed

Mr Mrs Miss Ms Other Please Specify __________________________________________________________________________

Page 1 of 2

TRN SSN SIN TIN NIN

H. EMPLOYMENT INFORMATION

Employment Status

OccupationEmployer/School NameAddressBusiness Phone Ext.# Start Date (DD/MM/YYYY) / /

Business Email Address

Gross Annual Income

Currency JMD USD CAN GBP

…………………………………….………….…………...............................………… …………………………………….………….…………...............................…….....……

Date (dd/mm/yyyy) Date Witnessed (dd/mm/yyyy)

FOR INTERNAL USE

CIF #………………………….....………… BRANCH........................................................…………………

CUSTMER SIGNATURE VERIFIED BY (NAME):…………….................……………………………………….....… SIGNATURE .……………………………….…....…..………….....……..............… DATE: ...............................

PEP / OTHER APPROVED BY: NAME:...................................................................................................................... SIGNATURE .……………………………….…....…..………….....……..............… DATE: ...............................

INTERNAL REFERENCE (EXISTING MEMBER ONLY) o Applicable o Not Applicable

NAME OF AUTHORIZING OFFICER:……………………...…………….........................………................................ POSITION OF AUTHORIZING OFFICER:……………………...…………….........................………..............

SIGNATURE OF AUTHORIZING OFFICER:……………………...…………….........................………................................………….……………………………………................................................ DATE: ...............................

Change of Name and / or Address (YES / NO )?: :_____________________

DATE: ...............................

CHANGES ENTERED BY:……………………...……………...……….....................………….……………………………………SIGNATURE .……………………………….…....…..………….....……..............… DATE: ...............................

CHANGES CONFIRMED BY:……………………...……………...……….....................………….……………………………………SIGNATURE .……………………………….…....…..………….....……..............… DATE: ...............................

CUST0MER TYPE: oVMBS Employee oVMBS Subsidiary Employee oVMBS Director oPEP oOther ____________________________________________________________

SIGNATURES

Signature of applicant Signature and Seal or Stamp of Witness

EMPLOYMENT INFORMATION

ACKNOWLEDGEMENTI acknowledge that information requested on this form is required for the purpose of the Society complying with its legal and regulatory requirements. In the event that full andadequate information is not provided to the Society, the Society hereby expressly reserves the right at its sole discretion to close the accounts upon giving at least fourteen (14) daysprior notice in writing.

DISCLOSUREThe Society is hereby entitled to disclose to third parties any information about the account holder and the accounts held by the account holder and shall not be liable whatsoever inrelation to any information disclosed in any or all of the following circumstances:a) To subsidiaries and affiliates of the Society including overseas operationsb) To provide your personal and non personal information to credit agencies or credit bureaus as a credit information provider or in response to credit inquiries by other financialinstitutions, credit agencies or credit bureaus AND to request personal and non personal information from credit agencies or credit bureaus, financial institutions or any creditor inrespect of your creditworthinessc) If the Society shall deem it necessary to make such disclosures to protect the interest of the Society from any harm, loss or injuryd) To comply with any requirement for disclosure imposed by law, pursuant to the directives of the court or such duly empowered government agency or departmente) In any other circumstances in which the account holder shall give written authorization to make such disclosure

I have reviewed, understood and agreed to be bound by the various terms and conditions of the account operation agreement and acknowledge that same may be amended by theSociety in its sole discretion at any time and from time to time, as permitted under those terms and conditions.

BPI/CIF/Member Information Form/MIF20130802-ver2.0 Page 2 of 2 Approved 20130624

If retired, please state previous occupation_____________________________________________________________________________________

CUSTOMER TYPE & CODES:

PROFESSION CODE: ____________________________ SALESPERSON CODE: _______________________________ OFFICER CODE: _______________________________

_________ Documents supporting the change presented (YES / NO )?: __________

Comments________________________________________________________________________________________________________________________________

FORM PREPARED BY:……………………...……………...……….....................………….…………………………………… SIGNATURE .……………………………….…....…..………….....……..............…