APPLICATION TO PURCHASE FOREIGN EXCHANGE (FX)*

Reference No. __________________

Date: __________________

I/We hereby apply to purchase foreign exchange with the following details:

APPLICANT:
Name: _________________________________________________________

CIF Number: __________________________________________________________

ID presented/Reference: __________________________________________________________

Residency: ( )Resident ( ) Non -resident

AMOUNT (in words) APPLIED FOR (Indicate foreign currency): _____________________________

AMOUNT (in figures): _____________________________

PURPOSE: (please check appropriate box)

 Trade (payment for importations)  Foreign/foreign currency loans1
 Inward Foreign Investments by Non-Residents1  Owed to Non-residents
 Repatriation of Capital  Owed to Offshore Banking Units
 Remittance of Profits/Dividends/Earnings  Owed to residents (FCDUs/EFCDUs)
 Remittance in FX equivalent of peso  Prepayment
funds (funded by FX remittance) in excess of  Regular Payment
investments made in the Philippines Debt Account No.: _______________
 Outward Investments by Residents:  Principal _______________________
 Direct Investment (Equity Capital)  Interest ________________________
 Debt Securities  Fees __________________________
 Equity Securities  Others
 Mutual Funds (MFs)/Unit Investment  Services
Trust Funds (UITFs)  Non-merchandise Insurance
 Intercompany Loans2  Premiums
 Claims/payables
 Purchase of real property abroad,
 Passenger Tickets
including condominium units
 Travel Expenses
 FX-denominated investment instruments
 Commissions
issued onshore by non-residents
 Professional/Management Fees
 Resident to resident transactions:
 Royalties
 Obligations payable to residents
 Communication Services
 Resident investments in instruments
 Others (Please specify) ______________3
(except bank deposits):
 Income Payment4
 Issued by other residents
 Transfers (e.g., grants, donations)
(Please specify: ____________________)
 Conversion to FX of peso deposit
 Held for sale/trading by banks operating
accounts of non-residents
in the Philippines, regardless of issuer

 Others (Please specify) ____________

FOREIGN EXCHANGE DISPOSITION:

 FOR CREDIT TO FCDU ACCOUNT5
 FOR DIRECT REMITTANCE Account No.: _________________________________
 Full Amount: ______________  Full Amount: ______________
 Partial Amount: ______________  Partial Amount: ______________

BENEFICIARY: (Except for travel purpose, medical expenses not yet incurred and sales proceeds of emigrant’s domestic assets if emigrant is still
in the country)
Name : _________________________________________________________________________________
Address : _________________________________________________________________________________
I hereby certify that no foreign exchange has been purchased either on spot or deliverables forward basis and/or no swap
contract/s has/have been entered into covering the same underlying transaction and that the foregoing information are true
and correct.

* To be accomplished for all FX purchases from AABs/AAB-forex corps

1 For BSP-registered loans/investments

2 Loans of residents to offshore parent companies/subsidiaries of residents with an original tenor of at least one (1) year

3 Such as Manufacturing Services, Maintenance and repairs, Postal and Courier, Computer and Information, Research and Development,
Advertising, market research and public opinion polling, Technical, trade-related, and other business services, BPO Services, Audio Visual and
related services, Other personal, cultural and recreational services, and Government goods and services

4 Other than those related to loans and investments

BBG-00054-01
Ver. 9.15.16
 _________________________________ _________________________________
Date of Application Signature Over Printed Name

BBG-00054-01
Ver. 9.15.16