CREDIT CARD APPLICATION

PREFERRED CARD TYPE

Note: All fields are required and must be filled-up. Please put N/A if not applicable.
PERSONAL INFORMATION
Name (First Name, Middle Name, Last Name, Suffix)
Mr.
Ms.
Mrs.
Dr.
Atty.
Engr.
______

Prime

Platinum

World

Credit Card Type to be granted shall be based on the review of Credit Card Division.

Gender
Male

Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)

Female

Date of Birth (mm/dd/yyyy)

Place of Birth (City/Country)

No. of Dependents

Nationality

sample

Highest Educational Attainment

High School
Post-Graduate
College

Civil Status
Single
Married

Undergraduate

Separated
Divorced

Widowed

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
Mothers Maiden Name (First Name, Middle Name, Last Name)

Home Ownership

Owned

Owned, Mortgaged

Rented

Car Ownership

Owned

Owned, Mortgaged

Leased
None
Length of Stay (months/years)

Home/Permanent Address (No., Street, Barangay, District, City/Municipality, Province, ZIP Code)
Present Address

Same as Home/Permanent Address

TIN

SSS/GSIS No.

Length of Stay (months/years)

Home Phone No. (Include Area Code)

Please state your relatives name and relation if YES.

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

Type of ID Submitted (at least one):

Mobile Phone No.

Personal E-mail Address

Name

YES

NO

YES

NO

Living with Parents

Relation

Passport

Driver's License
Voter's ID
TIN ID
SSS ID
WORK AND FINANCIAL INFORMATION
Designation/Position/Title
Rank
Self-Employed
Junior Management
Clerical/Rank & File
Senior Management
Major Industry of Employer/Company/Business
Accommodation/Food Services
Financial/Insurance Services
Administrative/Support Services
Government
Education
Information and Communication

Employment Type
Employed
Probationary
Self-Employed
Employer/Company/Business Name

Licensed Professional

Manufacturing
Transportation/Warehousing

Work/Business Address (Unit No./Floor, Building Name, Building/House No., Street, Barangay, City/Municipality, Province, ZIP Code)
Work/Business Phone No.

Length of Business Existence (For Self-Employed)

Years in Work/Business

Source(s) of Funds
Basic Annual Income
Other Source of Income / Amount per Annum
PhP 120,000 - PhP 499,999
Salary
Commission
PhP 1,000,000 and above
PhP 500,000 - PhP 999,999
Allowances
Business
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 PHP10,000.00. 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

Loan Amount / Loan Tenor

Account Type / Account Number
Credit Card Number

AUTOMATIC DEBIT ARRANGEMENT

Do you want to enroll in Automatic Debit
Arrangement?
Yes (Please accomplish details below.)

BILLING ALERTS

Note: The Automatic Debit Arrangement will take effect once

the service becomes available. Enrolled cardholders
will be notified accordingly prior to implementation.

No

Account Name

I understand that Cardholders are automatically enrolled in all electronic channels (E-mail, SMS, and
eSOA) of China Bank, for receipt of notices on various marketing promos and other advisories.
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

Minimum Amount Due
Total Amount Due

Name (First Name, Middle Name, Last Name)

Relation

FOR WORLD CARD. I understand that my Billing Statement shall be delivered to me via e-mail and
to my preferred mailing address:
Home
Work/Business.

PERSONAL REFERENCE (Any relative, friend and/or trade reference not living with you.)
Home/Office Phone No. (Include Area Code)

Mobile Phone No.

Address (No., Street, Barangay, District, City/Municipality, Province, ZIP Code)

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 as found in the Banks website 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.
I/We hereby affirm and acknowledge that I/we have carefully read, understood, and fully agreed to all the foregoing stipulations and the other terms and conditions contained on the reverse side/separate page hereof,
which are hereby also confirmed/conformed to by me/us even without my/our signature(s) thereon. I/We further affirm that at the time I/we affixed my/our signature(s) hereto all the blank spaces have been correctly
and completely filled up.

Principal Card Applicants Signature / Date

Supplementary 1 Card Applicants Signature / Date

Supplementary 2 Card Applicants Signature / Date

FOR BANKS USE ONLY

Program Code

Main Sales
Channel Code

Sub Sales
Channel Code

Area
Code

Region
Code

Agent Code
(Employee No.)

Referrers Name

ONL
Other Codes / Remarks

Waived Phone Verification

We certify that the above information, the attached documents, and their contents are true and correct,
according to the Banks records and according to depositors own declarations. We also certify that we have
verified the applicant signatures.

CBC Relationship

Current ADB in PHP

(months/years)

(Pure CASA and/or Other Investments)

SENIOR OFFICERS
ENDORSEMENT (if applicable)

Referring Branch

Branch Cashier

Yes

No

Recommended Credit Limit

Branch Head / Officer

Contact No(s)
Signature Over Printed Name / Date

Signature Over Printed Name / Date

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 (03-16) TMP

CREDIT CARD APPLICATION

Note: All fields are required and must be filled-up. Please put N/A if not applicable.
Principal Applicants Name (First Name, Middle Name, Last Name, Suffix)

Mr.

Ms.

Mrs.

Dr.

Atty.

Engr.

______

SUPPLEMENTARY 1
Name (First Name, Middle Name, Last Name, Suffix)

Mr.

Ms.

Mrs.

Dr.

Atty.

Engr.

Gender
Male

______

Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)

Date of Birth (mm/dd/yyyy)

Female

Place of Birth (City/Country)

sample

Highest Educational Attainment

High School
Post-Graduate
Undergraduate
College
Mothers Maiden Name (First Name, Middle Name, Last Name)

Civil Status
Single

Nationality
Married

Separated

Divorced

Have you stayed in the United States of America (USA) for at

least 183 consecutive days within the last three (3) years?
YES
NO
Home/Permanent Address (No., Street, Barangay, District, City/Municipality, Province, ZIP Code)

Present Address

Widowed

Length of Stay (months/years)

Same as Home/Permanent Address

TIN

SSS/GSIS No.

Employment Type
Employed
Self-Employed

Designation/Position/Title

Length of Stay (months/years)

Home Phone No. (Include Area Code)

Employer/Company/Business Name

Source(s) of Funds
Salary
Allowances
Commission
Business

Relationship to Principal Applicant

Type of ID Submitted (at least one):

Drivers License

Passport

Filipino

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

Voters ID

Mobile Phone No.

Personal E-mail Address

Major Industry of Employer/Company/Business

Accommodation/Food Services
Government
Administrative/Support Services
Information and Communication
Education
Manufacturing
Financial/Insurance Services
Transportation/Warehousing
TIN ID

SSS ID

SUPPLEMENTARY 2
Name (First Name, Middle Name, Last Name, Suffix)

Mr.

Ms.

Mrs.

Dr.

Atty.

Engr.

Gender
Male

______

Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.)

Date of Birth (mm/dd/yyyy)

Female

Place of Birth (City/Country)

sample

Highest Educational Attainment

High School
Post-Graduate
College

Civil Status
Undergraduate

Single

Nationality
Married

Separated

Divorced

Mothers 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
Home/Permanent Address (No., Street, Barangay, District, City/Municipality, Province, ZIP Code)

Present Address

Widowed

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

Length of Stay (months/years)

Same as Home/Permanent Address

TIN

SSS/GSIS No.

Employment Type
Employed
Self-Employed

Designation/Position/Title

Source(s) of Funds
Salary
Allowances
Commission
Business

Relationship to Principal Applicant

Type of ID Submitted (at least one):

YOU'RE JUST A STEP TOWARDS
GREATER SECURITY

Length of Stay (months/years)

Home Phone No. (Include Area Code)

Employer/Company/Business Name
Passport

Filipino

Drivers License

Voters ID

Mobile Phone No.

Personal E-mail Address

Major Industry of Employer/Company/Business

Accommodation/Food Services
Government
Administrative/Support Services
Information and Communication
Education
Manufacturing
Financial/Insurance Services
Transportation/Warehousing
TIN ID

SSS ID

CreditSafe is a credit card insurance that gives added peace of mind and security to you and your family if youre faced with lifes uncertainties. It pays for 3 times
your China Bank Credit Cards indebtedness or PHP600,000, whichever is lower, in the event of untimely death, total and permanent disability or first diagnosis of
critical illness. It also gives additional protection in cases of accidental death and dismemberment and temporary disablement.

BENEFITS OF CREDITSAFE ARE AS FOLLOWS:

BENEFICIARY DESIGNATION

KEY BENEFITS

DESCRIPTION

Death, Total & Permanent

Disability and Critical Illness

CreditSafe pays the bank an amount equal to 3 times your China Bank
Credit Cards indebtedness up to a maximum benefit of PHP600,000 in
case of loss of life, permanent disablement or first diagnosis of covered
critical illnesses. Any remainder of the benefit shall be given to you or your
beneficiaries.

BENEFICIARY

Accidental Death &

Dismemberment Benefit

If loss is due to accidental dismemberment, CreditSafe provides you an

additional benefit or your beneficiary (in case of accidental death) in
accordance to a specific schedule.

Total & Temporary Disability

Income

In case of temporary disablement of more than thirty (30) days, CreditSafe

pays off an amount equal to the monthly minimum amount due at the time
of disablement up to six (6) months, starting on the 31st day of temporary
disablement. Premiums due on the insurance will also be waived starting
on the 31st day for a maximum of six (6) months.

The monthly premium that will be charged to your China Bank Credit Card is 0.69% of your cards
outstanding balance, including any unbilled installment amount.

DATE OF BIRTH

Trustee if any beneficiary is under age 18

BENEFICIARYS RELATIONSHIP TO CARDHOLDER

Relationship of Trustee to Minor Beneficiary

Yes! I would like my China Bank Credit Card to be covered under CreditSafe that will pay off my
credit card bills in case of death, disability, or first diagnosis of covered critical illness.

OPTIONAL ENROLLMENT TO CREDITSAFE

In availing the benefits of CreditSafe, I declare and agree that:
The answers in my application form and any attachment to it is complete and true to the best of my knowledge and belief.
I am between 18-64 years old, in good health and have neither been hospitalized nor treated for any illness in the past twelve (12) months. I agree to be bound by all other terms and conditions of the policy certificate to be issued.
I am authorizing China Bank to collect and use the information disclosed in my China Bank Credit Card Application form, together with any subsequent changes to it collected by the Bank, to carry on its business. I am also granting
China Bank the authority to transfer such information to its associated companies, business partners, affiliates, advisors, representatives and any service providers for any legitimate purpose.
I am authorizing Manulife China Bank Life Assurance Corporation, as an insurance provider, to store, collect, record, organize, retrieve, consolidate, block, erase, transfer, properly use, and disclose to its affiliate companies,
subsidiaries, agents, principal or third parties providing services to Manulife China Bank Life Assurance Corporation (regardless of where they are located or registered), any information or matters pertaining to myself, this application,
or any updates thereof for the purpose of CreditSafe Insurance only.
I will notify Manulife China Bank Life Assurance Corporation, through China Bank, any change in information I provided in the application form or any document attached to it.
The features and benefits of CreditSafe and that the corresponding premiums will be charged to my China Bank Credit Card account.

Principal Applicants Name and Signature

Date

IMPORTANT: CreditSafe is underwritten by Manulife China Bank Life Assurance Corporation and is marketed by China Banking Corporation. Coverage under the insurance product is subject to Exclusions and Conditions of the Certificate.
Indebtedness means the amount equivalent to: 1) the closing balance, including any expenses of supplementary cardholders, and any fraction thereof shown on the last billing statement issued on the credit card prior to the covered event; plus 2) any
authorized transactions made on the credit card prior to the covered event which were not included in the said billing statement; plus 3) any applicable finance charges as of the date of the covered event; less 4) any temporary disablement or accidental
dismemberment benefit that has been paid to reduce the outstanding balance after the last billing statement and prior to the covered event, up to a maximum amount of 100% of the cardholders credit limit or Php 600,000, whichever is lower.
Benefits, if any, are payable to China Bank to pay-off your credit cards outstanding balance. Anything in excess shall be payable to the beneficiary stated above. Designated beneficiary should have an insurable interest to the cardholder. In the absence of
a designated beneficiary, any amount in excess shall be payable in accordance with the following: 1) to the cardholder in the event of benefits arising from Permanent Disablement, Temporary Disablement, Critical Illness or Accidental Dismemberment; 2)
To the person/s then surviving in the following order of preference: (a) widow or widower, (b) surviving children, (c) surviving parents, (d) surviving brothers / sisters, (e) executors or administrators, in the event of Benefits arising from Death.

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)