CREDIT CARD APPLICATION
Principal Cardholder
CBC Depositor Non-CBC Depositor
I am also applying for a Virtual Card (card for internet use only)
Monthly Spending Limit (MSL): ____________________
Note: Minimum MSL is PHP5,000.00. If no MSL is indicated, default MSL is PHP20,000.00.
The MSL is shared with the Principal Account’s credit limit.
Prime Platinum Cash Rewards Freedom World
Actual card issued may vary depending on credit evaluation
Name (First Name, Middle Name, Last Name, Suffix)
Name to Appear on Card (Maximum of 21 characters including spaces. Nicknames/Aliases not allowed)
Other Credit Card References (Please list down all active credit cards you own where you are the Principal Cardholder of at least 1 year)
Home Phone No. (include area code)
Date of Birth (mm/dd/yyyy)
Place of Birth (City, Country)
Mother’s Maiden Name (First Name, Middle Name, Last Name)
Highest Educational Attainment
High School Undergraduate
Rented Living with Parents
Home/Permanent Address (Unit No./Floor, Building Name, Building/House No., Street, Subdivision/Village, Barangay, City/Municipality, Province)
Length of Stay
(months/years)
Present Address (Unit No./Floor, Building Name, Building/House No., Street, Subdivision/Village, Barangay, City/Municipality, Province)
Length of Stay
(months/years)
Same as Home/
Permanent Address
Source(s) of Funds (Kindly select all applicable Source/s of Funds)
Business Commission Dividends Funds from Family Member Gifts and Donations Government Assistance Inheritance Interest
Investments Pension Profession Remittance Rent Salary Sale of Property Savings Winnings / Rewards
Employer/Company/Business Name
Occupation / Designation / Position / Title (Others, kindly specify in the blank)
Employed Retired Not Applicable _________________
Self-Employed (Business) Self-Employed (Professional)
Accountant Custom Broker Expatriate/Consular or Ambassadorial Staff
Jeweler Lawyer Money Changer Student __________________
Work/Business Address (Unit No./Floor, Building Name, Building No., Street, Subdivision/Village, Barangay, City/Municipality, Province, ZIP Code)
Nature of Business / Employment (Others, kindly specify in the blank)
Preferred Credit Card Delivery Address (Note: If blank, default will be the Present Address. The Bank may
deliver to any alternate address on record to ensure successful delivery.)
Present Address Office Address
Preferred Credit Card Statement of Account (SOA) Delivery Address (Note: If blank, default will be the Personal
e-mail address. The Bank may deliver to any alternate address on record to ensure successful delivery.)
Personal E-mail Address Office E-mail Address
Resident (Filipino / Alien / Special Resident Retiree’s Visa) ACR I-Card No. (if applicable) _______________________________________________
Non-Resident (Alien / Filipino Immigrant / OFWs with contract to work abroad for more than a year / Sea-based OFWs with immigrant or working visa)
*FCBS Non-Resident Indicator: Resident = NO ; Non-Resident = YES
TIN/SSS/GSIS ID
Voter’s ID
Driver’s License
__________________
1. Do you have relatives working in China Bank?
Name/Unit __________________________________________ Relationship ______________________
2. Are you / Are you related or associated to a person currently/formerly holding a position
in any branch of the Philippine or foreign government or an international organization?
Relationship with the government personnel: Occupying Relative Associate
(Position and Dept. of the Gov’t Personnel ___________________________________________ )
FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) INFORMATION
1. Are you a US Citizen/Green Card Holder or do you meet the Substantial Presence Test?
If YES, kindly accomplish FATCA Customer’s Information for U.S. Persons Form.
2. If No to Item No. 1. Do you have any of the following records in the US?
Mailing Address (including a U.S. Post Office Box)
Standing Instruction to transfer funds to accounts maintained in the U.S.
Do you have a Power of Attorney or signatory authority granted to a person with a U.S. Address; or “in-care-of” or “hold mail” address?
If YES, kindly submit the following Requirements: U.S. IRS Form W-8BEN* AND valid non-U.S. passport or any similar documentation establishing non-U.S. citizenship (e.g., Driver’s License, Tax Certificate issued by the Government)
Additional Requirement if Born in the U.S.: Copy of Individual’s Certificate of Loss of Nationality of the U.S. OR Written explanation of your renunciation of U.S. Citizenship or reason you did not obtain U.S. citizenship at birth
* Kindly ask the Bank for a copy of U.S. IRS Form W-8BEN (Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting - Individuals)
Name (First Name, Middle Name, Last Name, Suffix)
Home/Company/Business Address (Unit No./Floor, Building Name, Building No., Street, Subdivision/Village, Barangay, City/Municipality, Province)
Home/Company/Business Phone No.
By signing below, I confirm that the information provided in this application form is true and correct. I authorize China Banking Corporation (CBC)
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 consent and/or was authorized to
give consent to the collection, retention, processing, disclosure (as provided under applicable confidentiality and data privacy laws of the
Philippines including all subsequent amendments or supplements thereto) of any personal, sensitive personal and privileged information relating
to me, the Partnership/Corporation/Juridical Entity and its officers, directors and stockholders, whether provided by me or coming to CBC’s
possession, and sharing of the said personal, sensitive personal and privileged information to CBC and its offices, branches, subsidiaries and
affiliates (Chinabank Insurance Brokers, Inc., China Bank Securities Corporation, China Bank Capital Corporation, China Bank Savings, Inc.,
China Bank Properties and Computer Center, Inc., and Manulife-China Bank Life Assurance Corporation, among others), accredited third
parties/vendors, or other persons or entities that CBC may reasonably select, personal information processors, credit reporting or credit reference
agencies, credit protection provider, guarantee institutions, debt collection agencies, government agencies and private regulatory organizations
and other financial institutions, and other outsourced service providers engaged by CBC as allowed by law and internal Bank policies, for purposes
reasonably required by CBC such as, but not limited to, its conduct of everyday business (processing my Credit Card application and transactions,
maintenance of my account/s), performance of daily technological and operational functions, communications technology services including
updates and automation of the systems of CBC group and its affiliates, compliance with the law and regulatory organizations, research and
statistics including conduct of surveys, marketing and cross-selling of products and services of CBC, its subsidiaries and affiliates, client
relationship management, sales lead generation, running credit and negative information checks, conduct of skiptracing, asset and property search
and/or verification, statistical and risk analysis, data analytics, client profiling, and in the event of default arising from non-payment of my Credit
Card obligations with CBC, and all other purposes as allowed in the banking industry practice, businesses of CBC’s subsidiaries and affiliates,
and by law. I shall notify CBC in writing, which must be acknowledged by CBC, if I do not consent to the processing and disclosure of said
information with CBC’s representative offices, subsidiaries, affiliates, agents and accredited third parties/vendors or other persons or entities that
CBC may reasonably select. I further acknowledge my right to information, access, correction, rectification, erasure of my personal, sensitive
personal and privileged information, data portability, objection to processing, file complaint and damages under the Data Privacy Act.
I agree that CBC may retain my personal and account information for as long as necessary for the fulfilment of the purpose for which it was
collected and such other purposes that I may have consented to from time to time, as required by pertinent laws and regulations, and provide
information when required to do so in accordance with RA 1405, RA 6426, RA 8791, RA 9510, RA 9160, RA 10173, as amended, and other
similar and applicable laws, by court order, and jurisprudence. I agree that CBC shall not be liable for any loss or damage arising from CBC’s
disclosure of personal and account information for the above.
I consent and authorize the Land Registration Authority, Register of Deeds, Land Transportation Offices, local government unit offices, and other
government agencies and instrumentalities to give, provide, share, and disclose any and all information and documents as may be necessary and
required by the Bank and its authorized representatives, in connection with its conduct of skiptracing, asset and property search and/or verification.
In the FATCA Information section, if I answered “NO” to all items, I hereby certify that I am not a U.S. Person and WITHOUT U.S. Indicia. If I
answered “NO” to item 1 and “YES” to item 2, I hereby certify that I am not a U.S. Person but WITH U.S. Indicia. I undertake to submit the
required documents to support my Non-US Person status (with or without US Indicia). In the event that CBC discovers that I am a U.S. Person,
I hereby waive my rights of confidentiality under applicable laws and CBC and its authorized representative(s) are hereby absolutely and
unconditionally authorized to report and disclose to the U.S. IRS or Philippine Regulatory Agencies (e.g. Bureau of Internal Revenue, Bangko
Sentral ng Pilipinas, and the like) and/or any third party authorized to receive FATCA information, any and all information regarding my account
that shall be required. In the event of any change in my circumstance which may affect my status, I undertake and warrant that I will inform
CBC in writing of such change within thirty (30) calendar days from occurrence of such change.
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 CBC as well as any updates or corrections thereof. I understand that my credit data may be
shared by the CIC with other authorized lenders and duly accredited reporting agencies, for the purpose of establishing my credit worthiness.
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 CBC free and harmless from any liabilities that may arise
from any such collection, processing, use, retention, sharing, and disclosure of information relating to my accounts, properties, or investments
with CBC.
I understand that falsifying any information in the application or any of the enclosed documents is sufficient ground for legal action and for
rejecting my application. In the event that my application for a CBC Credit Card is disapproved, CBC is under no obligation to provide me with
the reason for such a decision. The accomplished application form and requirement(s) submitted become property of CBC. CBC is under no
obligation to return the said documents.
I further authorize CBC to conduct random verification with the Bureau of Internal Revenue (BIR) in order to establish the authenticity of the
BIR Form 2316 filed, submitted, duly stamped, and received by the BIR, together with the supporting financial statements, as applicable, and
such other documents required thereunder and hereby waive the benefit of confidentiality of client information in relation to said form and
financial statements (pursuant to BSP Circular No. 472 Series of 2005 as implemented by BIR Revenue Regulation RR-4 2005 and Section
X304.1 of the Bangko Sentral ng Pilipinas Manual of Regulations for Banks).
I agree to indemnify and hold free and harmless CBC, its subsidiaries and affiliates, as well as any of its officers, directors, and employees
against any and all losses, claims, damages, penalties, liabilities, choses of actions, and costs of any kind that may arise directly or indirectly
from the execution of this consent.
I hereby expressly agree to CBC’s credit policies and procedures in accordance with BSP Circular No. 855 (Sound Credit Risk Management
Practices), as well as other applicable and related laws/regulations.
By signing and/or using my CBC Credit Card(s), I agree to abide and be governed by Terms and Conditions governing the issuance and use
of the CBC Credit Card as found in CBC’s 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 CBC to submit my name in negative listing of any credit bureau or institution. I also hereby affirm and acknowledge that I have
understood and fully agreed that CBC may change any of the provisions in its Terms and Conditions and the fees and charges for its products
and/or services from time to time and I agreed to be notified of such changes through notice sent to me through any of the following means,
at the discretion of CBC, including, but not limited to, mail/e-mail/fax/SMS or telephone, and for any other purpose as CBC may deem
appropriate unless I request otherwise.
Applicant’s Signature Over Printed Name / Date
“We certify that the above information, the attached documents and their contents are true and correct, according to the Bank's records and according to depositor's own declarations.”
Branch Head/OIC/Area Head
Signature Over Printed Name / Date
Signature Over Printed Name / Date
Referrer’s Name
Employee Number ________________________________________________
CCD-032 (09-21) TMP
