Credit-Card-Application-with-Supplementary-TMP-Saveable.pdf

CREDIT CARD APPLICATION
Note: All fields are required and must be filled-up. Please put “N/A” if not applicable.
PREFERRED CARD TYPE

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.)

J

A

Y

A

R

A

C

B

U

S

A

P

D

A

M

Date of Birth (mm/dd/yy)

APRIL, 02 1983

A

Female

Place of Birth

MAKATI CITY

sample

Civil Status

Educational Attainment
Post-Graduate
Secondary
College

No. of Dependents

Single

Married

Widowed

1

Separated

Nationality
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

EMELINDA CABUS TABALNO

Car Ownership

Owned

Owned, Mortgaged

Leased

Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)

ZIP Code

359 LOURDES ST. CALOOCAN CITY

1410
ZIP Code

Permanent Home Address (If different from Present Address)

Living with Parents
None
Length of Stay
(years/months)
20

Length of Stay
(years/months)

-SAMETIN

SSS/GSIS No.

249-737-830

Home Phone No. (Include Area Code)

34-0856611-4

Mobile No.

[email protected]

Name

Please state your relative’s name and relation if YES.
Do you have relatives working in China Bank?

YES

NO

Do you have relatives who hold senior office in
the government, judicial, police, military, etc?

YES

NO

Type of ID Submitted (at least one):

Personal E-mail Address

+639984274554

Passport

Driver's License

Voter's ID

TIN ID

Relation

SSS ID

WORK AND FINANCIAL INFORMATION
Employment Status
Employed
Probationary
Self-Employed
Employer/Business Name

Occupation

Rank
Self-Employed
Junior Management
Licensed Professional
ENGR. II
Clerical/Rank & File
Senior Management
Industry Type/Nature of Business
Accommodation/Food Services
Financial/Insurance Services
Manufacturing
JGC PHILIPPINES
Administrative/Support Services
Government
Transportation/Warehousing
OIL AND GAS
Education
Information and Communication
Office/Business Address (Rm / Flr / No. / Bldg / Street / Village/Brgy. / Municipality/City / Province)
Zip Code

CIVIL ENGINEER

Office Phone No. (Include Area Code)

Source of Funds
Salary
Allowances

Commission
Business

Length of Business Existence

Basic Annual Income
PhP 120,000 - PhP 499,999
PhP 500,000 - PhP 999,999

EXISTING RELATIONSHIP WITH CHINA BANK
Bank Account Information
Do you have a current relationship with China Bank
Yes
No
(loan/deposit/investment)?
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

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.
I regret that I don’t have an e-mail address, kindly deliver my Statement of
Account to my preferred mailing address.
Preferred Mailing Address:

Home

Office

Send Notification/Alerts 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

Relation

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

FOR BANK’S
USE ONLY

Program Code

Sub Sales Channel Code

Region Code

Main Sales Channel Code

Area Code

Agent Code
CCD-013 (02-15) TMP

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
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

Nationality
Filipino

Separated

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
YES
NO
last three (3) years?
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)

U.S. Tax Account Number (if American citizen)

ZIP Code

Length of Stay
(years/months)

Permanent Home Address (If different from Present Address)

ZIP Code

Length of Stay
(years/months)

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

Personal 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
YES
NO
last three (3) years?
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)

Nationality
Filipino

Separated

U.S. Tax Account Number (if American citizen)

ZIP Code

Length of Stay
(years/months)

Permanent Home Address (If different from Present Address)

ZIP Code

Length of Stay
(years/months)

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

Personal 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