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) Mr. Ms. Mrs. Dr. Atty. Engr. ______ Gender
Male Female
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.) Date of Birth (mm/dd/yyyy) Place of Birth (City/Country)

sample

Highest Educational Attainment Civil Status No. of Dependents Nationality

High School Post-Graduate Undergraduate Single Separated Widowed
Filipino
College Married Divorced
Have you stayed in the United States of America (USA) for at least 183 consecutive days within the last three U.S. Tax Account Number (if American citizen)
(3) years? YES NO
Mothers Maiden Name (First Name, Middle Name, Last Name) Home Ownership Owned Owned, Mortgaged Rented Living with Parents
Car Ownership Owned Owned, Mortgaged Leased None
Home/Permanent Address (No., Street, Barangay, District, City/Municipality, Province, ZIP Code) Length of Stay (months/years)

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

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

Please state your relatives 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
YES NO
government, judicial, police, military, etc?
Type of ID Submitted (at least one): Passport Driver's License Voter's ID TIN ID SSS ID
WORK AND FINANCIAL INFORMATION
Employment Type Designation/Position/Title Rank
Employed Probationary Self-Employed Junior Management Licensed Professional
Self-Employed Clerical/Rank & File Senior Management
Employer/Company/Business Name Major Industry of Employer/Company/Business
Accommodation/Food Services Financial/Insurance Services Manufacturing
Administrative/Support Services Government Transportation/Warehousing
Education Information and Communication
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
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 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 BILLING ALERTS

Do you want to enroll in Automatic Debit
Arrangement?
Yes (Please accomplish details below.)
Account Name
Account Number to be Debited
Note: The Automatic Debit Arrangement will take effect once
the service becomes available. Enrolled cardholders
will be notified accordingly prior to implementation.
No
Automatic Debit Arrangement Amount to be Paid
Minimum Amount Due Total Amount Due
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.
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.)
Name (First Name, Middle Name, Last Name) Home/Office Phone No. (Include Area Code) Mobile Phone No.

Relation 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 SENIOR OFFICERS
Main Sales Sub Sales Area Region Agent Code
Program Code Referrers Name ENDORSEMENT (if applicable)
Channel Code Channel Code Code Code (Employee No.)

ONL Waived Phone Verification Yes No

Other Codes / Remarks We certify that the above information, the attached documents, and their contents are true and correct, Recommended Credit Limit
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 Referring Branch Branch Cashier Branch Head / Officer
(months/years) (Pure CASA and/or Other Investments)

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 Female
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.) Date of Birth (mm/dd/yyyy) Place of Birth (City/Country)

sample

Highest Educational Attainment Civil Status Nationality

High School Post-Graduate Undergraduate
Single Married Separated Divorced Widowed Filipino
College
Mothers Maiden Name (First Name, Middle Name, Last Name) Have you stayed in the United States of America (USA) for at U.S. Tax Account Number (if American citizen)
least 183 consecutive days within the last three (3) years?
YES NO
Home/Permanent Address (No., Street, Barangay, District, City/Municipality, Province, ZIP Code) Length of Stay (months/years)

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

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

Employment Type Designation/Position/Title Source(s) of Funds Major Industry of Employer/Company/Business

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

Type of ID Submitted (at least one): Passport Drivers License Voters ID TIN ID SSS ID
SUPPLEMENTARY 2
Name (First Name, Middle Name, Last Name, Suffix) Mr. Ms. Mrs. Dr. Atty. Engr. ______ Gender
Male Female
Name to Appear on Card (Maximum of 22 characters including spaces. Nicknames/Aliases are not allowed.) Date of Birth (mm/dd/yyyy) Place of Birth (City/Country)

sample

Highest Educational Attainment Civil Status Nationality

High School Post-Graduate Undergraduate Filipino
Single Married Separated Divorced Widowed
College
Mothers Maiden Name (First Name, Middle Name, Last Name) Have you stayed in the United States of America (USA) for U.S. Tax Account Number (if American citizen)
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) Length of Stay (months/years)

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

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

Employment Type Designation/Position/Title Source(s) of Funds Major Industry of Employer/Company/Business

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

Type of ID Submitted (at least one): Passport Drivers License Voters ID 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
YOU'RE JUST A STEP TOWARDS
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
GREATER SECURITY 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 BENEFICIARY DATE OF BIRTH BENEFICIARYS RELATIONSHIP TO CARDHOLDER
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
Death, Total & Permanent
case of loss of life, permanent disablement or first diagnosis of covered
Disability and Critical Illness
critical illnesses. Any remainder of the benefit shall be given to you or your
beneficiaries.
If loss is due to accidental dismemberment, CreditSafe provides you an
Accidental Death &
additional benefit or your beneficiary (in case of accidental death) in
Dismemberment Benefit
accordance to a specific schedule.
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
Total & Temporary Disability
of disablement up to six (6) months, starting on the 31st day of temporary
Income
disablement. Premiums due on the insurance will also be waived starting
on the 31st day for a maximum of six (6) months.
Trustee if any beneficiary is under age 18 Relationship of Trustee to Minor Beneficiary
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.

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)