Authority to Disclose Information

TIEZA form for authority to disclose information

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: APPENDIX 10.4
(As amended by Circular No. 838 dated 20 June 2014)


“The undersigned [name of foreign investor or duly authorized
representative of the foreign investor, pursuant to the sworn special authority (copy
attached1) issued by the foreign investor] hereby authorizes the [name of custodian
bank] to disclose to the BSP any information that may be required by the BSP
relative to any and all investments of [foreign investor] that are held in custody by
the bank.
It is understood that the aggregate data compiled by the BSP from such
disclosure/reports/documents submitted to it may be used, among others, in
statistical reports and/or policy studies.
This authority is given knowingly and voluntarily.



Executed by the investor for the authorized representative

Signature over Printed Name