Appendix 102

Appendix to Sec. 137 on Bio-data of Directors and Officers

	DEADLINE:	20 banking/business days from the annual election of the board of directors/trustees
	SUBMISSION:	Original copy to the appropriate supervising department of the Bangko Sentral

(Name of Bank/QB/NBFI/with Trust Authority/Trust Corporation/NBFI/NSSLA)
List of Members of the Board of Directors and Officers
As of __________________________________________

Name	Position	Department (if applicable)
Directors:
a
a
Officers with rank of senior vice president and above (or equivalent rank):
a
a
Officers   below the rank of senior vice president:
a
a
a

REPUBLIC OF THE PHILIPPINES)

____________________________ ) S.S.

I solemnly swear that all matters set forth in this report are true and correct, to the best of my knowledge and belief.

	(Signature of Authorized Signatory)

SUBSCRIBED AND SWORN TO BEFORE ME this____day of _____20__, affiant exhibiting to me his/her (valid identification document) No. ___________issued at ________ on _______20___.

	Notary Public
	Until December 31, 20_____ PTR No. ________________ Place __________________

Doc No. ________________
Page No. ________________
Book No. ________________
Series of _______________

(Circular Nos. 969 dated 22 August 2017 and 887 dated 07 October 2015)