Application Form for Businesses
Content
PNB CREDIT CARD APPLICATION FORM
Check your preferred PNB Credit Card:
PNB MasterCard
PNB-The Travel Club Platinum MasterCard
PNB-PAL Mabuhay Miles MasterCard
Other PNB Cards:
Scan the accomplished and signed form and send it via email to
[email protected] or fax to (02) 812-6247 /
(02) 892-7427. You may also submit this form at any PNB branch.
PNB UnionPay
PNB Visa
1. PERSONAL INFORMATION (BSP-REQUIRED)
First Name
Middle Name
Date of Birth
mm
Place of Birth
dd
Sex
Education
Male
Female
yyyy
Last Name
College
Some College
Graduate School
Present Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)
Nationality/Country of Citizenship
Filipino
ZIP Code
(Province/Region, Country)
No. of dependents:
Mother’s Full Maiden Name
High School
Status
Non-Filipino
(state country of citizenship)
Years of Stay
Single
Separated
Married
Widow
Choose one and provide the number
Is permanent residence address the same as present residence address?
Yes
Permanent Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)
SSS
No (please provide permanent
residence address below)
GSIS
Email
TIN
Mobile Number
Home Landline Number
(Province/Region, Country)
ZIP Code
With current relationship with PNB?
Home Ownership
Owned
Rented
P ____________________
Living with Relatives
Mortgage
P ____________________
Yes
No
PNB Account Number: ______________________________________________________________
Others _________________________
PNB Branch: ______________________________________________________________________
If you are a foreign national, you must submit photocopy of any of the following:
1. ACR / ICR or I-Card
2. Philippine Retirement Authority ID
And ANY of the following (check submitted I.D. / document)
Internal Revenue Service I.D. (IRS I.D.)
SSS I.D.
Work Permit Issued by DOLE (Mandatory if employed in the Philippines)
Passport with ACR
National I.D.
I.D. No. __________________________________
Expiry __________________________________
3. SOURCE OF FUNDS/INCOME (BSP-REQUIRED)
2. NATURE OF WORK / SELF-EMPLOYMENT / BUSINESS (BSP-REQUIRED)
Employed
Private
You may check more than one:
Own Business
Self-employed/Practicing Profession
Nature of Work/Profession/Business (Based on SEC/DTI/Business Permit):
Public
Name of Employer/Business
Position/Rank
Employer/Business Address (Unit #, Bldg./House #, Street, Barangay/District,
City, Province/Region, Country)
Previous Employer
ZIP Code
Employer Contact Number
No. of years with
previous employer
Position/Rank
Salary
Business Revenue
Ave. Monthly Amount:
Ave. Monthly Amount:
Commission
Professional Fees
Savings / Deposit /
Investments
Pension
Remittance
Ave. Monthly Amount:
Ave. Monthly Amount:
Ave. Daily Balance:
Ave. Monthly Amount:
Remitter Name:
Relationship with Applicant:
Country Origin of Remittance:
Ave. Monthly Amount:
Please specify type and amount:
Others:
4. YOUR NON-PNB CREDIT CARDS (at least one year principal ownership)
Credit Card Company
Card Number
Credit Limit
5. SPOUSE INFORMATION
First Name
Middle Name
Mother’s Full Maiden Name
Last Name
Employment Status
Employed
Self-employed
Business / Company Address (Number, Street, District, City/Province)
Date of Birth
mm
Unemployed
dd
yyyy
Citizenship
Filipino
Non-Filipino:
____________
Mobile Number
6. MABUHAY MILES MEMBERSHIP
Provide your Mabuhay Miles membership number in order to enjoy conversion of rewards points earned to Mabuhay Miles. A new Mabuhay Miles membership number will be auto-generated if the
Mabuhay Miles membership number portion below is left blank or an invalid number is provided. No adjustments can be made afterwards.
Are you a current member of Mabuhay Miles Club?
Yes
No
If you are, please indicate your existing Mabuhay Miles membership number:
8. SUPPLEMENTARY CARD (must be at least 13 years old) - LIFETIME ANNUAL FEE WAIVER
7. BILLING INFORMATION
Choose where you want your BILLING STATEMENT to be delivered:
Email
Home
Office
If Email is chosen, please choose where your CARD will be delivered:
Home
Office
Date of Birth
mm
dd
yyyy
Sex
Auto Debit my PNB Peso acct. #
Auto Debit my PNB Dollar acct. #
Full
Minimum
Full
Minimum
(For Auto Debit, if selection is not checked, payment will automatically be minimum.)
Status
Relationship with principal applicant
Mobile Number
Mother’s Full Maiden Name
Single
Married
Male
Female
Automatic Debit Arrangement (ADA) from your PNB Checking or
Savings Account
If you want to pay via ADA from your PNB CASA, please fill out below:
Last Name
Middle Name
First Name
Separated
Widow
Email Address
* Sub-limit
*For Sub-limit: Principal cardholder assigns sub-limit. Specify amount rounded off to the nearest thousand.
If not specified, default sub-limit is 100%.
Signature
9. DECLARATION
By signing below, I/we are applying for a PNB Credit Card. I/We agree to abide by and be governed by the Terms and Conditions governing the issuance and use of the PNB Credit Card and all future amendments thereto.
I/We authorize Philippine National Bank (PNB) to verify the information in this application and to receive and exchange information about me/us including requesting reports from PNB's consumer credit reporting or
reference or other accredited bureaus. I hereby acknowledge and authorize: 1) the regular submission and disclosure of my basic credit data (as defined under R.A. 9510 and its Implementing Rules and Regulations) to
the Credit Information Corporation (CIC) as well as any updates or corrections thereof; and 2) the sharing of my basic credit data with other lenders authorized by the CIC, and credit reporting agencies duly accredited by
CIC. I/We also authorized PNB and their affiliates to contact these sources for information at any time, to use information about me/us, including information from this application and from consumer credit reports, for
marketing and administrative purposes and to share such information with each other.
By signing up for this product and/or service, I/we authorize PNB, their branches, subsidiaries, affiliates, representatives, and their authorized third party service providers to collect, use, and disclose my personal data and
share such data for marketing and promotional purposes such as, but not limited to, calls, emails, and/or SMS. I/We may withdraw such consent at anytime by calling the PNB Credit Cards Customer Service or sending a
notification via mail or email to PNB.
I/We hereby agree to waive my/our right/s regarding the confidentiality of deposits under R.A. 1405, as amended, as the disclosure is necessary and relevant in the evaluation of my/our application for a PNB Credit Card
and to ensure a successful debit under an auto-debit payment agreement with my/our PNB account should I/we decide to avail of the auto-debit payment facility to my/our PNB Credit Card. I/We hereby authorize PNB,
in the event that my account becomes past due, to offset against my PNB deposit/s any upaid balances or to endorse my account to an accredited third party agency, and subsequently cancel my card. I/We further
authorize and consent to the Philippine National Bank to be the recipient of these information and to conduct random verification with the BIR in order to establish authenticity of the Income Tax Retur (ITR).
I/We hold ourselves, jointly and severally liable for all obligations and liabilities arising from the use of the PNB Credit Card and supplementary card/s and, in the event that my/our application for a PNB Credit Card is
disapproved, the Philippine National Bank is under no obligation to provide me/us with the reason for such a decision.
The accomplished application form and requirement/s submitted will become the property of the Philippine National Bank. The Philippine National Bank is under no obligation to return the said documents.
Further hereby declare, that in compliance with BSP Circular #472, I agree to send copy of my latest duly-stamped ITR or BIR Form 2316; or latest 3 months payslips, if employed; or Audited Financial Statements, if self-employed.
Source Code
FOR BANK USE ONLY
Program Name/Code:
Branch / Channel Code:
Employee No.:
Signature of Principal Applicant
PNB Credit Cards -- Miles and Miles Ahead
Date
Solicitor’s Name: ________________________________
CRR Code:
OPAF_April 2016
Check your preferred PNB Credit Card:
PNB MasterCard
PNB-The Travel Club Platinum MasterCard
PNB-PAL Mabuhay Miles MasterCard
Other PNB Cards:
Scan the accomplished and signed form and send it via email to
[email protected] or fax to (02) 812-6247 /
(02) 892-7427. You may also submit this form at any PNB branch.
PNB UnionPay
PNB Visa
1. PERSONAL INFORMATION (BSP-REQUIRED)
First Name
Middle Name
Date of Birth
mm
Place of Birth
dd
Sex
Education
Male
Female
yyyy
Last Name
College
Some College
Graduate School
Present Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)
Nationality/Country of Citizenship
Filipino
ZIP Code
(Province/Region, Country)
No. of dependents:
Mother’s Full Maiden Name
High School
Status
Non-Filipino
(state country of citizenship)
Years of Stay
Single
Separated
Married
Widow
Choose one and provide the number
Is permanent residence address the same as present residence address?
Yes
Permanent Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)
SSS
No (please provide permanent
residence address below)
GSIS
TIN
Mobile Number
Home Landline Number
(Province/Region, Country)
ZIP Code
With current relationship with PNB?
Home Ownership
Owned
Rented
P ____________________
Living with Relatives
Mortgage
P ____________________
Yes
No
PNB Account Number: ______________________________________________________________
Others _________________________
PNB Branch: ______________________________________________________________________
If you are a foreign national, you must submit photocopy of any of the following:
1. ACR / ICR or I-Card
2. Philippine Retirement Authority ID
And ANY of the following (check submitted I.D. / document)
Internal Revenue Service I.D. (IRS I.D.)
SSS I.D.
Work Permit Issued by DOLE (Mandatory if employed in the Philippines)
Passport with ACR
National I.D.
I.D. No. __________________________________
Expiry __________________________________
3. SOURCE OF FUNDS/INCOME (BSP-REQUIRED)
2. NATURE OF WORK / SELF-EMPLOYMENT / BUSINESS (BSP-REQUIRED)
Employed
Private
You may check more than one:
Own Business
Self-employed/Practicing Profession
Nature of Work/Profession/Business (Based on SEC/DTI/Business Permit):
Public
Name of Employer/Business
Position/Rank
Employer/Business Address (Unit #, Bldg./House #, Street, Barangay/District,
City, Province/Region, Country)
Previous Employer
ZIP Code
Employer Contact Number
No. of years with
previous employer
Position/Rank
Salary
Business Revenue
Ave. Monthly Amount:
Ave. Monthly Amount:
Commission
Professional Fees
Savings / Deposit /
Investments
Pension
Remittance
Ave. Monthly Amount:
Ave. Monthly Amount:
Ave. Daily Balance:
Ave. Monthly Amount:
Remitter Name:
Relationship with Applicant:
Country Origin of Remittance:
Ave. Monthly Amount:
Please specify type and amount:
Others:
4. YOUR NON-PNB CREDIT CARDS (at least one year principal ownership)
Credit Card Company
Card Number
Credit Limit
5. SPOUSE INFORMATION
First Name
Middle Name
Mother’s Full Maiden Name
Last Name
Employment Status
Employed
Self-employed
Business / Company Address (Number, Street, District, City/Province)
Date of Birth
mm
Unemployed
dd
yyyy
Citizenship
Filipino
Non-Filipino:
____________
Mobile Number
6. MABUHAY MILES MEMBERSHIP
Provide your Mabuhay Miles membership number in order to enjoy conversion of rewards points earned to Mabuhay Miles. A new Mabuhay Miles membership number will be auto-generated if the
Mabuhay Miles membership number portion below is left blank or an invalid number is provided. No adjustments can be made afterwards.
Are you a current member of Mabuhay Miles Club?
Yes
No
If you are, please indicate your existing Mabuhay Miles membership number:
8. SUPPLEMENTARY CARD (must be at least 13 years old) - LIFETIME ANNUAL FEE WAIVER
7. BILLING INFORMATION
Choose where you want your BILLING STATEMENT to be delivered:
Home
Office
If Email is chosen, please choose where your CARD will be delivered:
Home
Office
Date of Birth
mm
dd
yyyy
Sex
Auto Debit my PNB Peso acct. #
Auto Debit my PNB Dollar acct. #
Full
Minimum
Full
Minimum
(For Auto Debit, if selection is not checked, payment will automatically be minimum.)
Status
Relationship with principal applicant
Mobile Number
Mother’s Full Maiden Name
Single
Married
Male
Female
Automatic Debit Arrangement (ADA) from your PNB Checking or
Savings Account
If you want to pay via ADA from your PNB CASA, please fill out below:
Last Name
Middle Name
First Name
Separated
Widow
Email Address
* Sub-limit
*For Sub-limit: Principal cardholder assigns sub-limit. Specify amount rounded off to the nearest thousand.
If not specified, default sub-limit is 100%.
Signature
9. DECLARATION
By signing below, I/we are applying for a PNB Credit Card. I/We agree to abide by and be governed by the Terms and Conditions governing the issuance and use of the PNB Credit Card and all future amendments thereto.
I/We authorize Philippine National Bank (PNB) to verify the information in this application and to receive and exchange information about me/us including requesting reports from PNB's consumer credit reporting or
reference or other accredited bureaus. I hereby acknowledge and authorize: 1) the regular submission and disclosure of my basic credit data (as defined under R.A. 9510 and its Implementing Rules and Regulations) to
the Credit Information Corporation (CIC) as well as any updates or corrections thereof; and 2) the sharing of my basic credit data with other lenders authorized by the CIC, and credit reporting agencies duly accredited by
CIC. I/We also authorized PNB and their affiliates to contact these sources for information at any time, to use information about me/us, including information from this application and from consumer credit reports, for
marketing and administrative purposes and to share such information with each other.
By signing up for this product and/or service, I/we authorize PNB, their branches, subsidiaries, affiliates, representatives, and their authorized third party service providers to collect, use, and disclose my personal data and
share such data for marketing and promotional purposes such as, but not limited to, calls, emails, and/or SMS. I/We may withdraw such consent at anytime by calling the PNB Credit Cards Customer Service or sending a
notification via mail or email to PNB.
I/We hereby agree to waive my/our right/s regarding the confidentiality of deposits under R.A. 1405, as amended, as the disclosure is necessary and relevant in the evaluation of my/our application for a PNB Credit Card
and to ensure a successful debit under an auto-debit payment agreement with my/our PNB account should I/we decide to avail of the auto-debit payment facility to my/our PNB Credit Card. I/We hereby authorize PNB,
in the event that my account becomes past due, to offset against my PNB deposit/s any upaid balances or to endorse my account to an accredited third party agency, and subsequently cancel my card. I/We further
authorize and consent to the Philippine National Bank to be the recipient of these information and to conduct random verification with the BIR in order to establish authenticity of the Income Tax Retur (ITR).
I/We hold ourselves, jointly and severally liable for all obligations and liabilities arising from the use of the PNB Credit Card and supplementary card/s and, in the event that my/our application for a PNB Credit Card is
disapproved, the Philippine National Bank is under no obligation to provide me/us with the reason for such a decision.
The accomplished application form and requirement/s submitted will become the property of the Philippine National Bank. The Philippine National Bank is under no obligation to return the said documents.
Further hereby declare, that in compliance with BSP Circular #472, I agree to send copy of my latest duly-stamped ITR or BIR Form 2316; or latest 3 months payslips, if employed; or Audited Financial Statements, if self-employed.
Source Code
FOR BANK USE ONLY
Program Name/Code:
Branch / Channel Code:
Employee No.:
Signature of Principal Applicant
PNB Credit Cards -- Miles and Miles Ahead
Date
Solicitor’s Name: ________________________________
CRR Code:
OPAF_April 2016
