9/FLEGASPI SUITES, 178 SalcedoSt.

, Legaspi Village, Makati City, Philippines

Tel. Nos. 8182414 8184480 8180730 FaxNo. 8193294 E-mail: ghcsupercard@yahoo.com

MEMBERSHIP APPLICATION FORM

PART I -- MEMBER INFORMATION PART II -- MEMBERSHIP AGREEMENT
1. The SuperCard is a discount and insurance card and not a credit nor a
Member No. charge card. Itis non-transferable and mustbe presented bythe Member to
the affiliated medical doctors anddentists, hotels and resorts, and merchant
establishments (collectively referred to as “Affiliates”). The Member
agrees to be bound by the SuperCard Membership Agreement by
Surname signing and/ or using the card.
2. On a “best efforts basis”, GHC Supercard Corporation and its Affiliates
have signed an Affiliation or Partnership Agreement (referred to as the
First Name “Agreement”) forthe purposeof providing discountonprofessionalfees of
affiliated medical doctors and dentists, discount on prevailing room tariff
rates of affiliated hotels andresorts as well as discountonnon-saleitems or
Middle Name regular prices of merchant establishments to SuperCard Members.
Discounts on sale items and special offers are available solely at the
discretion of the merchant affiliates.
Nickname Civil 3. The SuperCard membership card must be shown to the Affiliates
Status before medical or dental consultation, during hotel or resort room
reservation, or before purchasing orat the time of payment, whichever
occurs first.
Nationality
4. All Affiliates have therighttorequest SuperCard Members to produce
proof of identityand/or toauthenticateSuperCard Member’ssignature.
Member
Sex M F Date of / / 5. While every endeavor is made to ensure that discounts are offered by
Birth reputable Affiliates, SuperCard does not accept anyresponsibility for
MONTH DAY YEAR the quality of medical or dental services provided, or the quality of the
Name of merchandise or hotel or resort service given nor omissions nor errors
Spouse containedin the Directory. SuperCard does notacceptanyliabilityfor
anyinjuryor illness, loss ordamagewhatsoeverresulting fromorduringa
visitor purchase fromanyAffiliatelisted intheDirectory. Inthe eventthat
Home listedAffiliates have closeddown orhavechanged ownership, the stated
Address discounts may no longer be available. The list of Affiliates in the
Directory issubject to change without prior notice.
6. All SuperCard Members must make their hotel or resort reservations
thru the GLOBAL HOL IDAY Club only and subject to prior
reservation of atleast48hours before check-indate.All expenses relatedto
hotel or resortoccupancyshallbe payable directly to the hotel or resort.
Spouse
Home Date / / 7. All SuperCard Members will be provided with Personal Accident
Phone No. of Birth Insurance coverage byMALAYAN INSURANCE COMPANY, INC. which
MONTH DAY YEAR shall be solely liable to all SuperCard Members.Therefore, GHC
SUPERCARD CORPORATION shall not be held liable against all
Home
Cellphone Fax No.
insurance claims by SuperCard Members.
8. Lost or damaged cards may be replaced only once by paying a
replacementfeeof P 500.00per card. However, in the event of a second
Name of replacement of the same card, the Member will be charged the full
Office annualmembership fee.
9. In the event the Member failed to receive the agreed discountbetween the
Address of Affiliates and SuperCard , the Member must report the transaction in
Office writing to SuperCard attaching the sales voucher or any evidence of the
transaction within 72 hours from the date of transaction. SuperCard
would investigate thesalestransactionandif warranted, SuperCard would
terminatetheAgreement withtheconcerned Affiliate.
10. In case of litigation, which may be filed arising from this Membership
Agreement by the Member, GHC SUPERCARD CORPORATION
Business Office reserves theright that thecasebefiled in the MakatiRegionalTrial Court
Phone No. Fax No. only, waiving any other venue therefore.

E-mail
Address PART III -- DECLARATION
I declare that all information provided in this form is true and correct.
BENEFICIARY By signing this form, I agree to be bound by the terms and conditions
(In case of of the above mentioned SuperCard MEMBERSHIPAGREEMENT. .
death of
Member)
Relationship Date X
to Member of Birth / /
Signature of Member Date
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MONTH DAY YEAR

D E T A IL S O F PA Y M E N T A R R A N G EM E N T B U S IN E S S C EN T ER IN F O R M A T IO N

CASH C R E D IT AT M B A N K ORIGIN OR LOCATION SALES AGENT

C A R D C A R D C H EC K

___________________ ___________________
P________ Code No. ___________ Code No. ___________
(N O T E: Fo r p aym en ts i n vo lv in g c re dit car d s a nd atm ca rd s, i nd i cate n am e of ca rd iss ue r, car d nu m b er , exp i ry d ate an d l as t 3 d igi ts, i f an y. )