CREDIT CARD APPLICATION

PREFERRED CARD TYPE Prime Platinum World

Note: All fields are required and must be filled-up. Please put “N/A” if not applicable. 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 Female
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.) Date of Birth (mm/dd/yy) Place of Birth

sample

Educational Attainment Civil Status No. of Dependents Nationality

Post-Graduate Secondary
Single Married Widowed Separated Filipino
College
Have you stayed in the United States of America (USA) for at least 183 consecutive days within the last U.S. Tax Account Number (if American citizen)
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 (months/years)

Permanent Home Address Same as Present Address ZIP Code Length of Stay (months/years)

TIN SSS/GSIS No. Home Phone No. (Include Area Code) Mobile No. Personal E-mail Address

Please state your relative’s name and relation if YES. Name Relation
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): Passport Driver's License Voter's ID TIN ID SSS ID
WORK AND FINANCIAL INFORMATION
Employment Status Position Rank
Employed Probationary Self-Employed Junior Management Licensed Professional
Self-Employed Clerical/Rank & File Senior Management
Employer/Business Name Industry Type/Nature of Business
Accommodation/Food Services Financial/Insurance Services Manufacturing
Administrative/Support Services Government Transportation/Warehousing
Education Information and Communication
Office/Business Address (Rm / Flr / No. / Bldg / Street / Village/Brgy. / Municipality/City / Province) Zip Code

Office Phone No. (Include Area Code) Length of Business Existence Job Tenure

Source of Funds Basic Annual Income Other Source of Income Amount of Other Income (Annual)
Salary Commission PhP 120,000 - PhP 499,999 PhP 1,000,000 and above
Allowances Business PhP 500,000 - PhP 999,999
EXISTING RELATIONSHIP WITH CHINA BANK OTHER BANK CARDS
Bank Account Information Must be a principal credit cardholder for at least one (1) year, with a minimum credit limit of PhP 10,000.00. Card must be issued in the Philippines.
Do you have a current relationship with China Bank
(loan/deposit/investment)? Yes No Card Issuer Card Number Credit Limit Member Since
Account Number/Type

Credit Card Number

AUTOMATIC DEBIT ARRANGEMENT BILLING ALERTS

Do you want to enroll in Automatic Debit Arrangement? Note: The Automatic Debit Arrangement will take
effect once the service becomes available. I understand that Cardholders are automatically enrolled in all electronic channels (E-mail,
Yes (Please accomplish details below.) Enrolled cardholders will be notified
accordingly prior to implementation.
SMS, and eSOA) of China Bank, for receipt of notices on various marketing promos and
No
other advisories.
Account Name
FOR PRIME AND PLATINUM CARDS. I understand that my Billing Statement shall be
delivered to me via e-mail in support of China Bank's efforts to reduce paper consumption.
Account Number to be Debited Automatic Debit Arrangement Amount to be Paid FOR WORLD CARD. I understand that my Billing Statement shall be delivered to me via e-
Minimum Amount Due Total Amount Due mail and to my preferred mailing address: Home Office.

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

FOR BANK’S USE ONLY SENIOR OFFICER’S ENDORSEMENT(if applicable)

Main Sales Sub Sales Region
Program Code Area Code Agent Code Waived Phone Verification Recommended Credit Limit
Channel Code Channel Code Code
ONL Yes No
Other Codes

Signature Over Printed Name / Date

The Principal and/or Supplementary Card Applicants must sign on the DECLARATION section of this Application Form. Only signed applications will be processed.
CCD-013 (09-15) P/T
 CREDIT CARD APPLICATION
Note: All fields are required and must be filled-up. Please put “N/A” if not applicable. Additional Supplementary and Declaration
Principal Applicant’s Name (First Name, Middle Name, Last Name, Suffix)

SUPPLEMENTARY 1
Name (First Name, Middle Name, Last Name, Suffix) Gender
Male Female
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.) Date of Birth (mm/dd/yy) Place of Birth

sample

Educational Attainment Civil Status Nationality

Post-Graduate College Secondary Single Married Widowed Separated Filipino
Mother’s Maiden Name (First Name, Middle Name, Last Name) Have you stayed in the United States of America U.S. Tax Account Number (if American citizen)
(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) ZIP Code Length of Stay (months/years)

Permanent Home Address Same as Present Address ZIP Code Length of Stay (months/years)

TIN SSS/GSIS No. Home Phone No. (Include Area Code) Mobile No. Personal E-mail Address

Employment Status Position Source of Funds Industry Type/Nature of Business

Employed Salary Allowances Accommodation/Food Services Government
Self-Employed Commission Business Administrative/Support Services Information and Communication
Education Manufacturing
Employer/Business Name Relationship to Principal Applicant Financial/Insurance Services Transportation/Warehousing

Type of ID Submitted (at least one): Passport Driver’s License Voter’s ID TIN ID SSS ID
SUPPLEMENTARY 2
Name (First Name, Middle Name, Last Name, Suffix) Gender
Male Female
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.) Date of Birth (mm/dd/yy) Place of Birth

sample

Educational Attainment Civil Status Nationality

Post-Graduate College Secondary Single Married Widowed Separated Filipino
Mother’s Maiden Name (First Name, Middle Name, Last Name) Have you stayed in the United States of America U.S. Tax Account Number (if American citizen)
(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) ZIP Code Length of Stay (months/years)

Permanent Home Address Same as Present Address ZIP Code Length of Stay (months/years)

TIN SSS/GSIS No. Home Phone No. (Include Area Code) Mobile No. Personal E-mail Address

Employment Status Position Source of Funds Industry Type/Nature of Business

Employed Salary Accommodation/Food Services Government
Self-Employed Commission Administrative/Support Services Information and Communication
Education Manufacturing
Employer/Business Name Relationship to Principal Applicant Financial/Insurance Services Transportation/Warehousing

Type of ID Submitted (at least one): Passport Driver’s License Voter’s ID TIN ID 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 hereby authorize the transfer, disclosure and communication of any information relating to my accounts with China Bank to any of the offices, branches, subsidiaries, affiliates, agents, and representatives of China Bank and third
parties selected by any of them for data processing/storage, customer satisfaction survey, products and service offers made to me through mail/e-mail/fax/SMS or telephone, and for any other purpose as China Bank may deem
appropriate, and as may be required by law or regulation. I hereby authorize the regular submission and disclosure to any and all credit information service providers such as, but not limited to, Credit Card Association of the
Philippines and Credit Information Corporation, of any information, whether positive or negative relating to my basic credit data (as defined under R.A. No. 9510) with China Bank as well as any updates or corrections thereof. The
foregoing constitutes my written consent for any such submission and disclosure of information relating to my accounts for the purpose indicated above and under applicable laws, rules and regulations. I agree to hold China Bank
free and harmless from any liabilities that may arise from any transfer, disclosure or storage of information relating to my accounts.
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 complete application form and requirements to: China Banking Corporation (CBC) Credit Card Division 5/F Philcom Bldg., Paseo De Roxas, Makati 1226 or any CBC Branch.
You may also send it via Fax (843-3681) or E-mail (cardsales@chinabank.ph)