7/23/2019 Bnavhs New Emds Uacs Enrollment Form

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Land Bank of the Philippines ExhibitB

_______________ Branch Class D

AGENCY AND MDS ACCOUNT ENROLLMENT AND MAINTENANCE FORM

/ New Enrollment Update Enrollment Delete Enrollment

AGENCY INFORMATION

Name of AgencBAUAN NATIONAL AGRICULTURAL & VOCATIONAL HIGH SCHOOL

S!ort NameBNAVHS

Addre""No.

Street #rg$D%"tr%ct M&n$C%t 'ro(%nce

)%p Code4201

DepartmentDep-Ed

Contact N&m*er

(043) 0!-0""#Area Code Tel+ No+ E,t+

Fa, N&m*erN/A

Area Code Tel+ No+ E,t+

C!ec- 'ref%,

N/A

C!ec- S&ff%,

N/A

#Tr #ranc! Code1001

#Tr Area Code0410

Agenc." Ema%l Addre""$%.d'e*%%.+%',**%%.+%'

L#' Ser(%c%ng #ranc!B

ACCOUNT ACCESS 'ROFILE

MDS CODE Acco&nt

Acco&nt Name Acco&nt No+ Organ%/at%on CodeF&nd%ng So&rce

Code Tpe

BNAVHS-S 23"4-001!-# 000100401" 01101101 DS

BNAVHS-OOE 23"4-001-! 000100401" 01101101 DS

BNAVHS-A/TL/RG 23"4-001#-4 000100401" 01101101 DS

BNAVHS-TL 23"4-001-2 000100401" 01101101 DS

ACIC NTA SOURCE / NTA DESTINATION / LDDA IC SOURCE / CHECBOO RE5UEST

AC0NO1LEDGEMENT

T*6 e7e %7 pp86+96% 9% %7 LANDBAN eDS :+6869-A++%9 I

DECENA H. CRU;AT 201"A9*%76?ed S6@9%7/6e S6@97e %e7 769ed N'e D9e

FOR #AN0 USE ONLY

SERVICING BRANCH/EO DS AND COLLECTIONS ANAGEENT DEARTENT

2er%f%ed *$Date C!ec-ed *$Date Appro(ed *$Date 2er%f%ed *$Date Enrolled *$Date Appro(ed *$Date

Distribution: Copy 1 MCMD Copy 2 Institutional Client Copy 3 Depository Bank

SAN AGUSTIN BAUAN BATANGAS

7/23/2019 Bnavhs New Emds Uacs Enrollment Form

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Note: !1" #lease $rite %Not Appli&able' or N(A' )or )iel*s $it+ no appli&able *ate an*(or %Not+in, -ollo$s' i..e*iately a)ter t+e last ite./

!2" #lease use a**itional s+eets i) ne&essary