CLASS B
LAND BANK OF THE PHILIPPINES
Solano Branch
weAccess ENROLLMENT AND MAINTENANCE AGREEMENT FORM
INSTITUTION PROFILE
Name of Institution Short Name
Address ZIP Code Country
No. Street Barangay/District Municipality/City Province
Contact Number Fax Number Tax Identification Number (TIN) Date of Incorporation
### - - - -
Area Code Telephone Number Ext. Area Code Telephone Number M M D D Y Y Y Y
BIR Registered Name Institution's Email Address1/ Client Type2/
SUBSIDIARIES
INSTRUCTIONS INSTITUTION NAME TAX IDENTIFICATION NUMBER (TIN)
- - -
- - -
THIRD PARTY ACCOUNTS
As Fund Transfer Destination
INSTRUCTIONS ACCOUNT TAG3/ ACCOUNT NUMBER
- -
- -
As Auto-Debiting Source
INSTRUCTIONS ACCOUNT TAG3/ ACCOUNT NUMBER
- -
- -
BILLS PAYMENT
INSTRUCTIONS MERCHANT NAME REFERENCE NUMBER
CHARGES (if any)
Total Number of weAcess USB/flash disk: Please put N/A if Not Applicable. Total Billing:
Cost of weAccess USB/flash disk in excess of three (3)
Cost of weAccess USB/flash disk Replacement
Cost of weAccess vToken Application
ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.
Signature over Printed Name of Authorized Signatory Date
FOR BANK USE
SERVICING BRANCH/EO SYSTEMS IMPLEMENTATION DEPARTMENT
Reviewed by Verified by Approved by Checked by Enrolled by Date
Distribution Copy 1 - SID Copy 2 - Institutional Client Copy 3 - Depository Branch
Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) Please use additional sheets, if necessary.
1/
The designated email address where notices from the weAccess Facility shall be sent.
2/
e.g. GOCC, NGA, LGU, Private Corporation, Partnership, Cooperative, SME, Educational and Health Institution, Development Partnet, Religious and
Charitable Organization, Commercial/Universal Bank, Thrift Bank, Rural Bank, Other Financial Intermediary, NGO/People Organization/Association,
Micro-Enterprise, Sole Proprietorship
CLASS B
3/
The designated account description with a maximum of 15 alphanumeric characters (e.g. Payroll Account).
page 1
CLASS B
ACCOUNT ACCESS PROFILE
INSTRUCTIONS ACCOUNT NUMBER ACCOUNT TAG1/
Add - -
AUTO CREDITING REQUEST AUTO DEBITING REQUEST
Authorization Rule Amount Range Authorization Rule Amount Range
ATM PAYROLL BILLS PAYMENT
Authorization Rule Amount Range Authorization Rule Amount Range
any one
ACCOUNT TAG MANAGEMENT REMITTANCE
Authorization Rule Amount Range Authorization Rule Amount Range
FUND TRANSFER CURRENT ACCOUNT SERVICES
Source Account Destination Account Checkbook Reorder
Authorization Rule Amount Range Authorization Rule Amount Range
FUND SWEEPING Mother Account Satellite Account
INWARD SWEEP OUTWARD SWEEP
(Group, Scheduled, Manual Inward Sweep Request) (Group, Outward Sweep Request)
Authorization Rule Amount Range Authorization Rule Amount Range
REPORTS Downloadable Reports Viewable Reports
Salary Related Reports Adhoc Reports - Bills Payment Gov't. Merchant Reports
ePayments Reports Loan Profile Reports Others
INSTRUCTIONS ACCOUNT NUMBER ACCOUNT TAG1/
- -
AUTO CREDITING REQUEST AUTO DEBITING REQUEST
Authorization Rule Amount Range Authorization Rule Amount Range
ATM PAYROLL BILLS PAYMENT
Authorization Rule Amount Range Authorization Rule Amount Range
ACCOUNT TAG MANAGEMENT REMITTANCE
Authorization Rule Amount Range Authorization Rule Amount Range
FUND TRANSFER CURRENT ACCOUNT SERVICES
Source Account Destination Account Checkbook Reorder
Authorization Rule Amount Range Authorization Rule Amount Range
FUND SWEEPING Mother Account Satellite Account
INWARD SWEEP OUTWARD SWEEP
(Group, Scheduled, Manual Inward Sweep Request) (Group, Outward Sweep Request)
Authorization Rule Amount Range Authorization Rule Amount Range
REPORTS Downloadable Reports Viewable Reports
Salary Related Reports Adhoc Reports - Bills Payment Gov't. Merchant Reports
ePayments Reports Loan Profile Reports Others
ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.
Signature over Printed Name of Authorized Signatory Date
Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) Please use additional sheets, if necessary.
1/
The designated account description with a maximum of 15 alphanumeric characters.
CLASS B
page 2
CLASS B
LAND BANK OF THE PHILIPPINES
Solano Branch
Name of Institution Short Name
0 0
USER PROFILE
Name
First Name Middle Name Last Name
Address ZIP Code Country
No. Street Barangay/District Municipality/City Province
User ID Position/Designation Gender Date of Birth Date of Birth E-mail Address
- -
M M D D Y Y Y Y
vToken ID Contact Number/s Civil Status Tax Identification Number (TIN)
NA Landline Mobile Single Divorced 000 - 000 - 000 - 000
Challenge Questions Married Separated FOR BANK USE ONLY
1. Mother's Complete Maiden Name Widowed Internet Password Mailer ID
2. Name of High School - - -
3. Grandfather's Name
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
✘ Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - 1 ✘ ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ ✘ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.
CLASS B
Signature over Printed Name of User Signature over Printed Name of Authorized Signatory Date
FOR BANK USE
SERVICING BRANCH/EO SYSTEMS IMPLEMENTATION DEPARTMENT
Reviewed by Verified by Approved by Checked by Enrolled by Date
Distribution Copy 1 - SID Copy 2 - Institutional Client Copy 3 - Depository Branch
Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) User ID must be composed of 6-8 alphanumeric characters, letters using upper cases only. The number zero should be written as "Ø"
to differentiate from the letter "O".
(3) Vtoken ID must be composed of 8 alphanumeric characters. The number zero should be written as "Ø" to differentiate from the letter "O".
1/
Authority of the designated user.
2/
Fund Management includes Auto Crediting, Auto Debiting and Fund Sweeping Modules. page 2
CLASS B
LAND BANK OF THE PHILIPPINES
Solano Branch
Name of Institution Short Name
0 0
USER PROFILE
Name
First Name Middle Name Last Name
Address ZIP Code Country
No. Street Barangay/District Municipality/City Province
User ID Position/Designation Gender Date of Birth Date of Birth E-mail Address
- -
M M D D Y Y Y Y
vToken ID Contact Number/s Civil Status Tax Identification Number (TIN)
NA Landline Mobile Single Divorced 000 - 000 - 000 - 000
Challenge Questions Married Separated FOR BANK USE ONLY
1. Mother's Complete Maiden Name Widowed Internet Password Mailer ID
2. Name of High School - - -
3. Grandfather's Name
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
✘ Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - 1 ✘ ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ ✘ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
CLASS B
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
INSTRUCTIONS USER TYPE1/ ACCOUNT NUMBER ACCESS RIGHTS (pls. check applicable modules)
Account Information Fund Transfer Current Account Services
- - ATM Payroll Bills Payment Report
Remittance Fund Management2/ Loan Profile
ACIC File Upload ECNOW Access
ACKNOWLEDGMENT
This serves as our application to your LANDBANK weAccess Facility. I/We hereby acknowledge to have read, understood and agreed to be bound by
the Terms and Conditions of the LANDBANK weAccess facility.
Signature over Printed Name of User Signature over Printed Name of Authorized Signatory Date
FOR BANK USE
SERVICING BRANCH/EO SYSTEMS IMPLEMENTATION DEPARTMENT
Reviewed by Verified by Approved by Checked by Enrolled by Date
Distribution Copy 1 - SID Copy 2 - Institutional Client Copy 3 - Depository Branch
Notes: (1) Please write "Not Applicable" or "N/A" for fields with no applicable data and/or "Nothing Follows" immediately after the last item.
(2) User ID must be composed of 6-8 alphanumeric characters, letters using upper cases only. The number zero should be written as "Ø"
to differentiate from the letter "O".
(3) Vtoken ID must be composed of 8 alphanumeric characters. The number zero should be written as "Ø" to differentiate from the letter "O".
1/
Authority of the designated user.
2/
Fund Management includes Auto Crediting, Auto Debiting and Fund Sweeping Modules. page 2
