CHINABANK Credit Card Application Public Supplementary Saveable
Content
CREDIT CARD APPLICATION
PREFERRED CARD TYPE
Note: All fields are required and must be filled-up. Please put “N/A” if not applicable.
Prime
Platinum
World
Credit Card Type to be granted shall be based on the review of Credit Card Division.
PERSONAL INFORMATION
Name (First Name, Middle Name, Last Name, Suffix)
Gender
Male
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)
Female
Date of Birth (mm/dd/yy)
Place of Birth
No. of Dependents
Nationality
sample
Civil Status
Educational Attainment
Post-Graduate
Secondary
College
Single
Married
Widowed
Separated
Filipino
U.S. Tax Account Number (if American citizen)
Have you stayed in the United States of America (USA) for at least 183 consecutive days within the last
three (3) years?
YES
NO
Mother’s Maiden Name (First Name, Middle Name, Last Name)
Home Ownership
Owned
Owned, Mortgaged
Rented
Living with Parents
Car Ownership
Owned
Owned, Mortgaged
Leased
None
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)
ZIP Code
Length of Stay (years/months)
Permanent Home Address
ZIP Code
Length of Stay (years/months)
Same as Present Address
SSS/GSIS No.
TIN
Home Phone No. (Include Area Code)
Mobile No.
Name
Please state your relative’s name and relation if YES.
Do you have relatives working in China Bank?
YES
Do you have relatives who hold senior office in
the government, judicial, police, military, etc?
YES
Type of ID Submitted (at least one):
E-mail Address
Passport
Relation
NO
NO
Driver's License
Voter's ID
TIN ID
SSS ID
WORK AND FINANCIAL INFORMATION
Employment Status
Employed
Probationary
Self-Employed
Employer/Business Name
Occupation
Rank
Self-Employed
Junior Management
Clerical/Rank & File
Senior Management
Industry Type/Nature of Business
Accommodation/Food Services
Financial/Insurance Services
Administrative/Support Services
Government
Education
Information and Communication
Licensed Professional
Manufacturing
Transportation/Warehousing
Zip Code
Office/Business Address (Rm / Flr / No. / Bldg / Street / Village/Brgy. / Municipality/City / Province)
Office Phone No. (Include Area Code)
Source of Funds
Salary
Allowances
Length of Business Existence
Basic Annual Income
PhP 120,000 - PhP 499,999
PhP 500,000 - PhP 999,999
Commission
Business
EXISTING RELATIONSHIP WITH CHINA BANK
Bank Account Information
Do you have a current relationship with China Bank
(loan/deposit/investment)?
Yes
No
Account Number/Type
Job Tenure
Other Source of Income
Amount of Other Income (Annual)
PhP 1,000,000 and above
OTHER BANK CARDS
Must be a principal credit card holder for at least one (1) year, with a minimum credit limit of PhP 10,000.00. Card must be issued in the Philippines.
Card Issuer
Card Number
Credit Limit
Member Since
Credit Card Number
AUTOMATIC DEBIT ARRANGEMENT
Do you want to enroll in Automatic Debit Arrangement?
Yes
BILLING ALERTS
No
If yes, please indicate China Bank Account Number to be debited.
Account Name
Account Number
Automatic Debit Arrangement Amount to be Paid
Minimum Amount Due
Total Amount Due
FOR PRIME AND PLATINUM CARDS. I understand that my Billing Statements
shall be delivered to me via e-mail in support of China Bank’s efforts to reduce
paper consumptions. For other notifications/alerts, I prefer to receive them via:
E-mail
SMS
Both
FOR WORLD CARD. I understand that my Billing Statement shall be delivered to
me via e-mail and to my preferred mailing address:
Home
Office. For other
notifications/alerts, I prefer to receive them via:
E-mail
SMS
Both
PERSONAL REFERENCE (Any relative, friend and/or trade reference not living with you.)
Name (First Name, Middle Name, Last Name)
Address (No. / Street / Village / Brgy. / Municipality / City / Province)
Home/Office Phone No. (Include Area Code)
Mobile Number
Program Code
FOR
BANK’S
USE
ONLY
Main Sales Channel Code
Sub Sales Channel Code
Area Code
O
N
L
Relation
SENIOR OFFICER’S ENDORSEMENT
(if applicable)
Region Code
Agent Code
Free Text
Signature Over Printed Name / Date
Please submit/mail complete application form and requirements to: China Banking Corporation Credit Card Division 5/F Philcom Bldg,. Paseo de Roxas, Makati City 1226
CCD-013 (04-15) P/T
CREDIT CARD APPLICATION
Additional Supplementary and Declaration
Note: All fields are required and must be filled-up. Please put “N/A” if not applicable.
Principal Applicant’s Name (First Name, Middle Name, Last Name, Suffix)
SUPPLEMENTARY 1
Gender
Name (First Name, Middle Name, Last Name, Suffix)
Male
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)
Date of Birth (mm/dd/yy)
Female
Place of Birth
sample
Educational Attainment
Post-Graduate
College
Civil Status
Single
Secondary
Married
Widowed
Mother’s Maiden Name (First Name, Middle Name, Last Name)
Have you stayed in the United States of America
(USA) for at least 183 consecutive days within the
last three (3) years?
YES
NO
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)
Permanent Home Address
U.S. Tax Account Number (if American citizen)
Same as Present Address
TIN
SSS/GSIS No.
Home Phone No. (Include Area Code)
Mobile No.
Employment Status
Employed
Self-Employed
Occupation
Source of Funds
Salary
Commission
Industry Type/Nature of Business
Accommodation/Food Services
Administrative/Support Services
Education
Financial/Insurance Services
Employer/Business Name
Allowances
Business
Relationship to Principal Applicant
Type of ID Submitted (at least one):
Passport
Driver’s License
Voter’s ID
TIN ID
Nationality
Filipino
Separated
ZIP Code
Length of Stay (years/months)
ZIP Code
Length of Stay (years/months)
E-mail Address
Government
Information and Communication
Manufacturing
Transportation/Warehousing
SSS ID
SUPPLEMENTARY 2
Name (First Name, Middle Name, Last Name, Suffix)
Gender
Male
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)
Date of Birth (mm/dd/yy)
Female
Place of Birth
sample
Educational Attainment
Post-Graduate
College
Civil Status
Single
Secondary
Married
Widowed
Mother’s Maiden Name (First Name, Middle Name, Last Name)
Have you stayed in the United States of America
(USA) for at least 183 consecutive days within the
last three (3) years?
YES
NO
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)
Permanent Home Address
U.S. Tax Account Number (if American citizen)
Same as Present Address
TIN
SSS/GSIS No.
Home Phone No. (Include Area Code)
Mobile No.
Employment Status
Employed
Self-Employed
Occupation
Source of Funds
Salary
Commission
Industry Type/Nature of Business
Accommodation/Food Services
Administrative/Support Services
Education
Financial/Insurance Services
Employer/Business Name
Type of ID Submitted (at least one):
Relationship to Principal Applicant
Passport
Driver’s License
Voter’s ID
TIN ID
Nationality
Filipino
Separated
ZIP Code
Length of Stay (years/months)
ZIP Code
Length of Stay (years/months)
E-mail Address
Government
Information and Communication
Manufacturing
Transportation/Warehousing
SSS ID
DECLARATION
By signing below, I/we confirm that the information provided in this application form is true and correct. I/We authorize China Banking Corporation and its affiliates/authorized agents to verify and investigate the
information contained herein or any document/paper submitted in connection herewith, as well as updates or corrections thereof, from whatever sources it may deem appropriate.
I/We understand that falsifying any information in this application or on any of the enclosed documents is sufficient ground for legal action and for rejecting my application. In the event that my/our application for
a China Bank Credit Card is disapproved, China Bank is under no obligation to provide me/us with the reason for such a decision.
By enrolling in Automatic Debit Arrangement (ADA), I consent that repayment be facilitated by deducting the ADA Amount to be Paid stated above (minimum/total amount due) of outstanding balance as of last
statement date from my enrolled bank account on due date.
I understand that as the Principal Card Applicant, I must countersign on the preceding pages of this application form for validation purposes.
By signing and using my China Bank Credit Card, I/We agree to abide and be governed by the Terms and Conditions governing the issuance and use of the China Bank Credit Card and all future amendments
thereto. Furthermore, I, as the principal cardholder, hold myself jointly and severally liable for all obligations and liabilities incurred by my Supplementary Cardholder(s). In the event of delinquency, I hereby
authorize China Banking Corporation to submit my name in negative listing of any credit bureau or institution.
The accomplished application form and requirement(s) submitted, become property of China Bank. China Bank is under no obligation to return the said documents.
Principal Card Applicant’s Signature / Date
Supplementary 1 Card Applicant’s Signature / Date
Supplementary 2 Card Applicant’s Signature / Date
Please submit/mail complete application form and requirements to: China Banking Corporation Credit Card Division 5/F Philcom Bldg,. Paseo de Roxas, Makati City 1226
PREFERRED CARD TYPE
Note: All fields are required and must be filled-up. Please put “N/A” if not applicable.
Prime
Platinum
World
Credit Card Type to be granted shall be based on the review of Credit Card Division.
PERSONAL INFORMATION
Name (First Name, Middle Name, Last Name, Suffix)
Gender
Male
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)
Female
Date of Birth (mm/dd/yy)
Place of Birth
No. of Dependents
Nationality
sample
Civil Status
Educational Attainment
Post-Graduate
Secondary
College
Single
Married
Widowed
Separated
Filipino
U.S. Tax Account Number (if American citizen)
Have you stayed in the United States of America (USA) for at least 183 consecutive days within the last
three (3) years?
YES
NO
Mother’s Maiden Name (First Name, Middle Name, Last Name)
Home Ownership
Owned
Owned, Mortgaged
Rented
Living with Parents
Car Ownership
Owned
Owned, Mortgaged
Leased
None
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)
ZIP Code
Length of Stay (years/months)
Permanent Home Address
ZIP Code
Length of Stay (years/months)
Same as Present Address
SSS/GSIS No.
TIN
Home Phone No. (Include Area Code)
Mobile No.
Name
Please state your relative’s name and relation if YES.
Do you have relatives working in China Bank?
YES
Do you have relatives who hold senior office in
the government, judicial, police, military, etc?
YES
Type of ID Submitted (at least one):
E-mail Address
Passport
Relation
NO
NO
Driver's License
Voter's ID
TIN ID
SSS ID
WORK AND FINANCIAL INFORMATION
Employment Status
Employed
Probationary
Self-Employed
Employer/Business Name
Occupation
Rank
Self-Employed
Junior Management
Clerical/Rank & File
Senior Management
Industry Type/Nature of Business
Accommodation/Food Services
Financial/Insurance Services
Administrative/Support Services
Government
Education
Information and Communication
Licensed Professional
Manufacturing
Transportation/Warehousing
Zip Code
Office/Business Address (Rm / Flr / No. / Bldg / Street / Village/Brgy. / Municipality/City / Province)
Office Phone No. (Include Area Code)
Source of Funds
Salary
Allowances
Length of Business Existence
Basic Annual Income
PhP 120,000 - PhP 499,999
PhP 500,000 - PhP 999,999
Commission
Business
EXISTING RELATIONSHIP WITH CHINA BANK
Bank Account Information
Do you have a current relationship with China Bank
(loan/deposit/investment)?
Yes
No
Account Number/Type
Job Tenure
Other Source of Income
Amount of Other Income (Annual)
PhP 1,000,000 and above
OTHER BANK CARDS
Must be a principal credit card holder for at least one (1) year, with a minimum credit limit of PhP 10,000.00. Card must be issued in the Philippines.
Card Issuer
Card Number
Credit Limit
Member Since
Credit Card Number
AUTOMATIC DEBIT ARRANGEMENT
Do you want to enroll in Automatic Debit Arrangement?
Yes
BILLING ALERTS
No
If yes, please indicate China Bank Account Number to be debited.
Account Name
Account Number
Automatic Debit Arrangement Amount to be Paid
Minimum Amount Due
Total Amount Due
FOR PRIME AND PLATINUM CARDS. I understand that my Billing Statements
shall be delivered to me via e-mail in support of China Bank’s efforts to reduce
paper consumptions. For other notifications/alerts, I prefer to receive them via:
SMS
Both
FOR WORLD CARD. I understand that my Billing Statement shall be delivered to
me via e-mail and to my preferred mailing address:
Home
Office. For other
notifications/alerts, I prefer to receive them via:
SMS
Both
PERSONAL REFERENCE (Any relative, friend and/or trade reference not living with you.)
Name (First Name, Middle Name, Last Name)
Address (No. / Street / Village / Brgy. / Municipality / City / Province)
Home/Office Phone No. (Include Area Code)
Mobile Number
Program Code
FOR
BANK’S
USE
ONLY
Main Sales Channel Code
Sub Sales Channel Code
Area Code
O
N
L
Relation
SENIOR OFFICER’S ENDORSEMENT
(if applicable)
Region Code
Agent Code
Free Text
Signature Over Printed Name / Date
Please submit/mail complete application form and requirements to: China Banking Corporation Credit Card Division 5/F Philcom Bldg,. Paseo de Roxas, Makati City 1226
CCD-013 (04-15) P/T
CREDIT CARD APPLICATION
Additional Supplementary and Declaration
Note: All fields are required and must be filled-up. Please put “N/A” if not applicable.
Principal Applicant’s Name (First Name, Middle Name, Last Name, Suffix)
SUPPLEMENTARY 1
Gender
Name (First Name, Middle Name, Last Name, Suffix)
Male
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)
Date of Birth (mm/dd/yy)
Female
Place of Birth
sample
Educational Attainment
Post-Graduate
College
Civil Status
Single
Secondary
Married
Widowed
Mother’s Maiden Name (First Name, Middle Name, Last Name)
Have you stayed in the United States of America
(USA) for at least 183 consecutive days within the
last three (3) years?
YES
NO
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)
Permanent Home Address
U.S. Tax Account Number (if American citizen)
Same as Present Address
TIN
SSS/GSIS No.
Home Phone No. (Include Area Code)
Mobile No.
Employment Status
Employed
Self-Employed
Occupation
Source of Funds
Salary
Commission
Industry Type/Nature of Business
Accommodation/Food Services
Administrative/Support Services
Education
Financial/Insurance Services
Employer/Business Name
Allowances
Business
Relationship to Principal Applicant
Type of ID Submitted (at least one):
Passport
Driver’s License
Voter’s ID
TIN ID
Nationality
Filipino
Separated
ZIP Code
Length of Stay (years/months)
ZIP Code
Length of Stay (years/months)
E-mail Address
Government
Information and Communication
Manufacturing
Transportation/Warehousing
SSS ID
SUPPLEMENTARY 2
Name (First Name, Middle Name, Last Name, Suffix)
Gender
Male
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)
Date of Birth (mm/dd/yy)
Female
Place of Birth
sample
Educational Attainment
Post-Graduate
College
Civil Status
Single
Secondary
Married
Widowed
Mother’s Maiden Name (First Name, Middle Name, Last Name)
Have you stayed in the United States of America
(USA) for at least 183 consecutive days within the
last three (3) years?
YES
NO
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)
Permanent Home Address
U.S. Tax Account Number (if American citizen)
Same as Present Address
TIN
SSS/GSIS No.
Home Phone No. (Include Area Code)
Mobile No.
Employment Status
Employed
Self-Employed
Occupation
Source of Funds
Salary
Commission
Industry Type/Nature of Business
Accommodation/Food Services
Administrative/Support Services
Education
Financial/Insurance Services
Employer/Business Name
Type of ID Submitted (at least one):
Relationship to Principal Applicant
Passport
Driver’s License
Voter’s ID
TIN ID
Nationality
Filipino
Separated
ZIP Code
Length of Stay (years/months)
ZIP Code
Length of Stay (years/months)
E-mail Address
Government
Information and Communication
Manufacturing
Transportation/Warehousing
SSS ID
DECLARATION
By signing below, I/we confirm that the information provided in this application form is true and correct. I/We authorize China Banking Corporation and its affiliates/authorized agents to verify and investigate the
information contained herein or any document/paper submitted in connection herewith, as well as updates or corrections thereof, from whatever sources it may deem appropriate.
I/We understand that falsifying any information in this application or on any of the enclosed documents is sufficient ground for legal action and for rejecting my application. In the event that my/our application for
a China Bank Credit Card is disapproved, China Bank is under no obligation to provide me/us with the reason for such a decision.
By enrolling in Automatic Debit Arrangement (ADA), I consent that repayment be facilitated by deducting the ADA Amount to be Paid stated above (minimum/total amount due) of outstanding balance as of last
statement date from my enrolled bank account on due date.
I understand that as the Principal Card Applicant, I must countersign on the preceding pages of this application form for validation purposes.
By signing and using my China Bank Credit Card, I/We agree to abide and be governed by the Terms and Conditions governing the issuance and use of the China Bank Credit Card and all future amendments
thereto. Furthermore, I, as the principal cardholder, hold myself jointly and severally liable for all obligations and liabilities incurred by my Supplementary Cardholder(s). In the event of delinquency, I hereby
authorize China Banking Corporation to submit my name in negative listing of any credit bureau or institution.
The accomplished application form and requirement(s) submitted, become property of China Bank. China Bank is under no obligation to return the said documents.
Principal Card Applicant’s Signature / Date
Supplementary 1 Card Applicant’s Signature / Date
Supplementary 2 Card Applicant’s Signature / Date
Please submit/mail complete application form and requirements to: China Banking Corporation Credit Card Division 5/F Philcom Bldg,. Paseo de Roxas, Makati City 1226
