Appendix 120

FORMAT CERTIFICATION ON COMPLIANCE WITH REQUIREMENTS ON DIVIDEND DECLARATION
(Appendix to Sec. 124 on Reporting and Verification)

______________________________________
Name of Bank

CERTIFICATION

We, (Name of Officer), President (or Officer of Equivalent Rank) and (Name of Officer), Chief Compliance Officer, in behalf of (Name of Bank), with office address at (Head/Principal Office), after having been duly sworn to in accordance with law, hereby certify that the bank’s dividend declaration as of (date of dividend declaration), as approved by the board of directors (state resolution number and date), to the bank’s stockholders of record as of (record date) amounting to (amount of cash/stock/property dividend declaration) complies with the provisions of Sec. 124.

We further certify that at the time of dividend declaration, the bank has complied with the following:

a. Clearing account with the Bangko Sentral is not overdrawn;

b. Liquidity floor requirement for government funds; (for banks)

c. Minimum capitalization requirement and risk-based capital ratios as provided under applicable and existing capital adequacy framework;¹

d. The combined requirement for capital conservation buffer and the countercyclical capital buffer as defined in Appendix 59, (for UBs/ KBs and their subsidiary banks and QBs)

e. Higher loss absorbency requirement as provided under Sec. 128; (for identified Domestic Systematically Important Banks and their subsidiary banks and QBs)

f. Has not committed any unsafe or unsound banking practice and/or major acts or omissions as may be determined by the Bangko Sentral;

g. Has accumulated reserves of P ______________ for the retirement of the government preferred stock which is at least equal to the amount prescribed in Sec. 124-C (for rural and cooperative banks);

h. Has complied with the provisions of Article 86 of R.A. No. 9520, its By-Laws and other applicable laws, rules and regulations on the allocation and distribution of net surplus (for cooperative banks);

i. Has complied with the provisions of Section 43 (Power to declare dividends) of The Corporation Code of the Philippines (Batas Pambansa Blg. 68), as may be applicable; and

j. Has complied with the provisions of revised implementing rules and regulations to R.A. No. 7656, ‘An Act Requiring Government-Owned and/or Controlled Corporations to Declare Dividends Under Certain Conditions to the National Government, and for Other Purposes”(for Government-Owned bank

To the best of our knowledge, the foregoing statements are true and correct.

President		Chief Compliance Officer
TIN: Com. Tax Cert. No.: lssued on: lssued at		TIN: Com. Tax Cert. No.: lssued on: lssued at

Subscribed and sworn to before me, this ___day of _____________ 20___at ________________ exhibiting his/her respective Community Tax Certificate as indicated above.

NOTARY PUBLIC

Doc. No. _____________
Page No. _____________
Book No. _____________
Series of : _____________.

(Circular No. 1024 dated 06 December 2018, 888 dated 09 October 2015, and 930 dated 18 November 2016)

1. We also certify that the bank also apply with this requirement even after dividend distribution.