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Before filling-out the application form, please read the agreement on the reverse side.

Plese fill-out application form


properly, placing N/A for items not applicable. Incomplete applications will not be processed.
REQUIREMENTS:
FOR EMPLOYED INDIVIDUALS FOR SELF-EMPLOYED
• Latest 1” x 1” ID picture • Latest 1” x 1” ID picture
• Latest Income Tax Return and Certificate of Employment • Registration Papers with DTI or SEC
• Accomplished Application Form • Accomplished Application Form ID PHOTO
• Latest Payslip • Latest Audited Financial Statements and ITR
• Valid ID • Valid ID
• Co-obligor (for those renting) • Co-obligor (for those renting)
PERSONAL DATA
Application is for:

Local Classic Local Gold International Classic International Gold

Last Name First Name Middle Name

Name to appear in the card


if space is not sufficient
Birthdate (mm/dd/yyyy) Citizenship TIN/ACR No. GSIS/SSS No. Sex Civil Status No. of Dependents

Present Home Address (for those renting or living with relatives) Renting P /month
Living With Relatives
Permanent Address Owned
Mortgaged P /month
Residing Since No. of Owned Cars, if Any Mother's Maiden Name
Landline/s (include area code) Mobile Phone Number
Previous Address Reason for Leaving

Company Name and Address

Nature of Business Employed Since Telephone Number Position

Other Sources of Income Annual Amount


Personal Reference (Nearest Relative Not Living with You) Address
Telephone Number
SPOUSE'S PERSONAL DATA
Last Name First Name Middle Name

Company Name and Address

Nature of Business Employed Since Telephone Number Position

REQUEST FOR EXTENSION CARD (must be between 18 to 65 years old)


Last Name First Name Middle Name

Birthdate (mm/dd/yyyy) Tel. No. Relationship Signature

Last Name First Name Middle Name

Birthdate (mm/dd/yyyy) Tel. No. Relationship Signature

Last Name First Name Middle Name

Birthdate (mm/dd/yyyy) Tel. No. Relationship Signature

DEPOSIT ACCOUNTS
Bank Name and Branch Account Type Approximate Balance

CREDIT EXPERIENCE
Bank/Institution Type of Loan No. Of Years to Pay Approximate Balance

Other Credit Cards


Credit Card Company Account No. Credit Limit Approximate Balance

I/we certify that all the above information are true and correct. I/we hereby authorize Land Bank of the Philippines to verify and investigate said information and such other information which Land Bank of the Philippines may deem necessary.
I/we acknowledge that I/we have read and understood the Land Bank of the Philippines Visa Card agreement on the reverse side hereof, and hereby agree to be bound by the same. In case of disapproval of my/our application, Land Bank of the
Philippines is under no obligation to provide me/us with the reason for such a decision.

Applicant Spouse Co-Obligor


TERMS AND CONDITIONS GOVERNING THE ISSUANCE AND USE OF LANDBANK VISA CARD

The cardholder agrees to be governed by the following terms and conditions upon signing of the 12. ASSIGNABILITY OF RECEIVABLES
application for the issuance of his/her LANDBANK VISA CARD. Accounts receivables from CARDHOLDER may be sold by ISSUER to any other party, without need of
notice nor consent of CARDHOLDER and without recourse.
1. DEFINITION OF TERMS
VISA means LANDBANK VISA credit card; 13. DEFAULT, ATTORNEY’S FEES, VENUE
ISSUER means the LAND BANK OF THE PHILIPPINES/EQUITABLE CARDNETWORK INC.; In case of default in the payment of CARDHOLDER’S obligation, the right to use the VISA shall
CARDHOLDER means the person to whom or for whose use a card is issued by the ISSUER; automatically be terminated and CARDHOLDER shall refrain from further using such VISA and surrender
EXTENSION CARDHOLDER means any person who upon application of cardholder is issued a VISA card; the same to ISSUER on demand. In addition to interest charges provided for under this agreement, the
COMPANY means a partnership/corporation/other entity which applies for a corporate credit card for the CARDHOLDER shall pay monthly late payment penalty service charge of 5.5% for overdue Peso account
use of its personnel; and 4.5% for overdue Dollar account or at such rate as may be imposed by ISSUER. If the collection
CO-OBLIGOR means any person who binds himself/herself/itself to be jointly or severally liable for the of account is referred to a collection agency and/or through the intervention of a lawyer, CARDHOLDER
payment of all charges incurred through the use of the VISA agrees to pay the cost of collection or attorney’s fees equivalent to 25% of the unpaid balance. An
additional amount equivalent to 25% of the unpaid balance exclusive of litigation expenses and judicial
2. MEMBERSHIP AND ANNUAL FEES cost shall be charged to CARDHOLDER as liquidated damages. Venue of all suits shall be in the court of
CARDHOLDER and EXTENSION CARDHOLDER shall pay an initial membership fee and, thereafter, an proper jurisdiction of Manila, or any province or city where any of the ISSUER’S branches is located, at
annual fee in such amount as may be fixed by the ISSUER. the option of the ISSUER.

3. RESPONSIBILITY OF CARDHOLDERS 14. TERMINATION


Unless otherwise provided herein, CARDHOLDERS agree to assume full responsibility for all obligation and In the event of the withdrawal of the principal or any extension CARDHOLDER’S privileges for whatever
charges incurred through the use of VISA, including but not limited to all cash advances, fees and penalties. reason, including but not limited to the CARDHOLDER’S failure to comply with any of the terms and
conditions herein provided, his death or insolvency (however evident), all privileges granted hereunder
4. ATM CASH ADVANCE to the CARDHOLDER, including cost and attorney’s fee, shall immediately become due and demandable
ATM cash advances made through the use of the VISA shall be subject to such interest and service without the necessity of demand which CARDHOLDER hereof expressly waives.
charges that the ISSUER shall have prescribed at the time the advances are made.
15. COMPANY ACCOUNTS
5. VISA NON-TRANSFERABLE A COMPANY which applies for VISA for the use of and in the name of its personnel shall furnish ISSUER
The VISA will remain the sole property of the ISSUER, it is not transferable and will be honored by together with the application for membership, a board resolution authorizing (i) the application for
ISSUER’S affiliated merchant only when properly signed and presented by the authorized CARDHOLDER membership, (ii) the issuance of the VISA to such authorized personnel, and (iii) the designation of an
or EXTENSION CARDHOLDER. The privileges of the VISA may be terminated or suspended by ISSUER officer of the company to sign for and in behalf of the COMPANY. The authorized officer and personnel
at any time and for whatever cause and CARDHOLDER agrees to surrender his/her VISA upon demand shall be jointly and severally liable together with the COMPANY for all charges arising from the use
of any of the ISSUER’S representatives. In the event of such termination or suspension, CARDHOLDER of such VISA, irrespective of whether the charges were incurred for the interest and benefit of the
agrees that he/she shall not have any claim demand or right of action against the ISSUER, and shall hold COMPANY or for the personal interest or benefit of the authorized officers and personnel.
the ISSUER free and harmless from any claim and damages arising from such termination or suspension.
Continued use of the VISA after receipt of the notice of termination shall be considered fraudulent. 16. LIMITATION OF LIABILITY
In the event of any action arising from this Agreement or any incident thereto relative to the use or
6. EXPIRY AND RENEWAL OF THE VISA dishonor of the VISA which CARDHOLDER may file against ISSUER, ISSUER’S liability will not exceed
Unless earlier terminated, voluntarily cancelled, or returned by the CARDHOLDER, the VISA shall be One Thousand Pesos (P1,000.00) Philippine currency or the amount of damages actually proved to have
valid only up to the date indicated thereon. Renewal of the VISA shall be solely dependent on the been suffered by the CARDHOLDER, whichever is less.
discretion of ISSUER. If not renewed, the CARDHOLDER’S entire obligation shall become due and
demandable without further notice. 17. CHANGE OF ADDRESS
CARDHOLDER agrees to immediately notify ISSUER of any change of his/her residence, office or mailing
7. LOSS OF THE VISA address, otherwise, ISSUER shall effect immediate suspension of his credit privileges. The monthly
In the event that the VISA is lost or stolen, CARDHOLDER agrees to immediately report as lost in writing Statement of Account shall be mailed by ISSUER to the latest reported mailing address of CARDHOLDER.
to ISSUER during regular working hours stating the place, the date and the circumstances of the loss
and the last purchases made prior to the loss. However, purchases made/incurred arising from the use 18. EXTENSION VISA
of the lost/stolen VISA before receipt by ISSUER of the written notice of loss shall be for the exclusive Should an EXTENSION VISA be issued upon CARDHOLDER’S request, the CARDHOLDER shall be
account of CARDHOLDER even if the signature of the CARDHOLDER is forged. CARDHOLDER continues responsible for all the charges including all fees, interest and service charges incurred through the use of
to be liable for all obligations incurred through the use of the VISA until the expiration of ten (10) regular EXTENSION VISA. CARDHOLDER shall continue to be responsible for all such charges incurred through
working days from the date of receipt of such written notice of loss. the use of EXTENSION VISA unless CARDHOLDER requests in writing that the extension be cancelled or
suspended. The principal CARDHOLDER and EXTENSION CARDHOLDERS shall be jointly and severally
Should CARDHOLDER fail to report immediately in writing the loss of the VISA to ISSUER after discovery liable for the payment of the purchases incurred through the use of the EXTENSION VISA.
and to state the required information as to place, date and last purchase made, it shall be deemed proof
that CARDHOLDER fraudulently made use of the VISA, and ISSUER or its affiliated merchants shall be 19. CO-OBLIGOR
rendered free and harmless from any and all liability arising out of the loss or theft of the VISA. Unless otherwise waived, the CARDHOLDER shall furnish an acceptable CO-OBLIGOR who shall be
jointly and severally liable with CARDHOLDER to pay ISSUER all the obligations and charges incurred
8. DISHONORED VISA and credit extended through the use of VISA and/or EXTENSION VISA. In the event the CO-OBLIGOR
ISSUER shall not be responsible to CARDHOLDER if for any reason, the VISA is not honored by affiliated subsequently withdraws, the CO-OBLIGOR shall notify CARDHOLDER and ISSUER in writing of such
merchants. The CARDHOLDER agrees to hold ISSUER free and harmless from any liability as a result withdrawal in which case the CO-OBLIGOR shall be discharged, provided that the CO-OBLIGOR’S liability
of the failure of any affiliated merchant to honor the VISA. Furthermore, ISSUER shall not be held liable on the VISA which he/she/it is bound to pay shall cover all charges incurred through the use of the VISA
for any defective product or service purchased through VISA. up to ten (10) days after receipt of such notice by the CO-OBLIGOR.

9. CREDIT LIMIT In such event, CARDHOLDER must immediately furnish a new CO-OBLIGOR acceptable to ISSUER,
The credit limit represents maximum outstanding balance of the purchases and advances that CARDHOLDER otherwise, CARDHOLDER’S privileges shall automatically be terminated.
including EXTENSION CARDHOLDER may be allowed at any given time. ISSUER reserves the right to deny
authorization for any requested charges to CARDHOLDER’S account in case he/she exceeds his/her credit 20. DOLLAR DEPOSIT ACCOUNT
limit, otherwise, all charges shall become due and demandable without notice pending full settlement Unless otherwise waived, application for INTERNATIONAL GOLD and CLASSIC VISA require a minimum
thereof. The ISSUER shall have the option of reinstating the CARDHOLDER’S privileges. deposit of US$5,000.00 and US$3,000.00, respectively, with the LAND BANK OF THE PHILIPPINES or
such amount as may be required by the ISSUER. An additional deposit in the same account shall be
10. PAYMENT OF CHARGES required for every EXTENSION VISA issued. Amount due from CARDHOLDER arising out of or resulting
ISSUER shall furnish CARDHOLDER a monthly statement of account and CARDHOLDER agrees to pay all from the use of the VISA abroad shall be debited against CARDHOLDER’S US dollar deposit.
charges within the period as stated in the said statement. If the last day of payment falls on a Saturday,
Sunday or holiday, the last day of payment automatically becomes the first banking day prior to said 21. AUTHORITY TO DEBIT DEPOSIT ACCOUNT
payment date. The CARDHOLDER agrees to pay the interest at prevailing market rate per annum for INTERNATIONAL VISA CARDHOLDERS agree to pay all charges incurred out of the issuance and/or use of
late payments on all charges. All checks shall be made payable to LANDBANK VISA. such VISA through a debit to CARDHOLDER’S /CO-OBLIGOR’S and/or COMPANY’S US dollar deposit account.

CARDHOLDER hereby authorizes ISSUER to correspondingly increase or reduce the rates of such 22. WITHDRAWAL FROM DEPOSIT ACCOUNT
interest without advance notice to the CARDHOLDER in the event that the applicable rate of such Withdrawal from the US dollar deposit account for purposes other than the billing within a period of
interest is adjusted by law or the Bangko Sentral ng Pilipinas. ninety (90) days from the date of suspension or cancellation of the INTERNATIONAL VISA shall require
prior approval of ISSUER.
In addition to the VISA number embossed on the card, the statement of account issued shall bear a
base number for control purposes. 23. AMENDMENTS
Upon written notice to CARDHOLDER, ISSUER may, at any time and for whatever reason it may deem
Statement of account, mailed/delivered to CARDHOLDER in his billing address stated in the application reasonable, amend, revise or modify this Agreement or CARDHOLDER’S credit limit and any such
form shall be conclusively deemed received. If no error is reported by the CARDHOLDER within 15 days amendment shall bind CARDHOLDER upon receipt of notice thereof unless the CARDHOLDER objects
from receipt of the statement, it will be considered as correct. thereto by manifesting his/her intention to terminate his/her membership in writing and surrendering
the VISA within fifteen (15) days from receipt of notice of amendment. Failure to notify ISSUER of the
11. DEPOSIT ACCOUNT CARDHOLDER’S intention to terminate his/her membership and/or the continued use of the VISA by
Unless otherwise waived, the CARDHOLDER agrees to open/maintain a deposit account with LANDBANK CARDHOLDER shall be construed as acceptance by CARDHOLDER of the amendments to this Agreement.
and maintain the minimum balance that may be required. Should the CARDHOLDER fail to pay his/her
outstanding VISA obligation or die leaving an unpaid VISA account, the amount thereof shall be charged 24. SEPARABILITY CLAUSE
to said deposit account, and for this purpose, CARDHOLDER hereby gives authority in favor of ISSUER Should any provision of this Agreement be declared unconstitutional, invalid or unenforceable by
to debit automatically, without notice to CARDHOLDER, his/her deposit account for such amount as may a court of competent jurisdiction, such declaration shall not affect in any manner whatsoever, the
be sufficient to cover the payment of his/her outstanding balance. constitutionality, validity or enforceability of the other provisions of this Agreement.