CREDIT CARD APPLICATION

PREFERRED CARD TYPE

Note: All fields are required and must be filled-up. Please put N/A if not applicable.

Prime

Platinum

World

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)

Gender
Male

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

Female

Date of Birth (mm/dd/yy)

Place of Birth

No. of Dependents

Nationality

sample

Civil Status

Educational Attainment
Post-Graduate
Secondary
College

Single

Married

Widowed

Separated

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

Living with Parents

Car Ownership

Owned

Owned, Mortgaged

Leased

None

Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)

ZIP Code

Length of Stay (years/months)

Permanent Home Address

ZIP Code

Length of Stay (years/months)

Same as Present Address

SSS/GSIS No.

TIN

Home Phone No. (Include Area Code)

Mobile No.

Name

Please state your relatives name and relation if YES.

Do you have relatives working in China Bank?

YES

Do you have relatives who hold senior office in

the government, judicial, police, military, etc?

YES

Type of ID Submitted (at least one):

E-mail Address

Passport

Relation

NO
NO
Driver's License

Voter's ID

TIN ID

SSS ID

WORK AND FINANCIAL INFORMATION

Employment Status
Employed
Probationary
Self-Employed
Employer/Business Name

Occupation

Rank
Self-Employed
Junior Management
Clerical/Rank & File
Senior Management
Industry Type/Nature of Business
Accommodation/Food Services
Financial/Insurance Services
Administrative/Support Services
Government
Education
Information and Communication

Licensed Professional

Manufacturing
Transportation/Warehousing
Zip Code

Office/Business Address (Rm / Flr / No. / Bldg / Street / Village/Brgy. / Municipality/City / Province)

Office Phone No. (Include Area Code)

Source of Funds
Salary
Allowances

Length of Business Existence

Basic Annual Income

PhP 120,000 - PhP 499,999
PhP 500,000 - PhP 999,999

Commission
Business

EXISTING RELATIONSHIP WITH CHINA BANK

Bank Account Information
Do you have a current relationship with China Bank
(loan/deposit/investment)?
Yes
No
Account Number/Type

Job Tenure

Other Source of Income

Amount of Other Income (Annual)

PhP 1,000,000 and above

OTHER BANK CARDS

Must be a principal credit card holder for at least one (1) year, with a minimum credit limit of PhP 10,000.00. Card must be issued in the Philippines.

Card Issuer

Card Number

Credit Limit

Member Since

Credit Card Number

AUTOMATIC DEBIT ARRANGEMENT

Do you want to enroll in Automatic Debit Arrangement?

Yes

BILLING ALERTS
No

If yes, please indicate China Bank Account Number to be debited.

Account Name

Account Number

Automatic Debit Arrangement Amount to be Paid

Minimum Amount Due

Total Amount Due

FOR PRIME AND PLATINUM CARDS. I understand that my Billing Statements

shall be delivered to me via e-mail in support of China Banks efforts to reduce
paper consumptions. For other notifications/alerts, I prefer to receive them via:
E-mail
SMS
Both
FOR WORLD CARD. I understand that my Billing Statement shall be delivered to
me via e-mail and to my preferred mailing address:
Home
Office. For other
notifications/alerts, I prefer to receive them via:
E-mail
SMS
Both

PERSONAL REFERENCE (Any relative, friend and/or trade reference not living with you.)
Name (First Name, Middle Name, Last Name)

Address (No. / Street / Village / Brgy. / Municipality / City / Province)

Home/Office Phone No. (Include Area Code)

Mobile Number

Program Code

FOR
BANKS
USE
ONLY

Main Sales Channel Code

Sub Sales Channel Code

Area Code
O

Relation

SENIOR OFFICERS ENDORSEMENT

(if applicable)

Region Code
Agent Code

Free Text
Signature Over Printed Name / Date

Please submit/mail complete application form and requirements to: China Banking Corporation Credit Card Division 5/F Philcom Bldg,. Paseo de Roxas, Makati City 1226
CCD-013 (04-15) P/T

CREDIT CARD APPLICATION

Additional Supplementary and Declaration

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)

CELSO GARCIA MATIBAG

SUPPLEMENTARY 1
Gender

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

KEVIN
KEVIN CHRISTIAN
CHRISTIAN SANTOS
SANTOS MATIBAG
MATIBAG

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

Date of Birth (mm/dd/yy)

11/08/92

Male

Female

Place of Birth

Las Pinas

sample

Educational Attainment
Post-Graduate College

Civil Status
Single

Secondary

Married

Widowed

Nationality
Filipino

Separated

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
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)

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

Amalia Dionisio Santos

ZIP Code

53 Evelyn Camus St., BF Resort Village, Talon Dos, Las Pinas City
Permanent Home Address

Same as Present Address

SSS/GSIS No.

TIN

1740
ZIP Code

Home Phone No. (Include Area Code)

Mobile No.

Occupation

Source of Funds
Salary
Commission

Employer/Business Name

Allowances
Business

Relationship to Principal Applicant

Length of Stay (years/months)

E-mail Address

kevinmatibag@gmail.com

09176510225
Employment Status
Employed
Self-Employed

Length of Stay (years/months)

22 years

Industry Type/Nature of Business

Accommodation/Food Services
Administrative/Support Services
Education
Financial/Insurance Services

Government
Information and Communication
Manufacturing
Transportation/Warehousing

son
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)

Gender
Male

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

Date of Birth (mm/dd/yy)

Female

Place of Birth

sample

Educational Attainment
Post-Graduate
College

Civil Status
Single

Secondary

Married

Widowed

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
Present Home Address (No. / Street / Village / Brgy. / Municipality / City / Province)

Permanent Home Address

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

Same as Present Address

TIN

SSS/GSIS No.

Home Phone No. (Include Area Code)

Mobile No.

Employment Status
Employed
Self-Employed

Occupation

Source of Funds
Salary
Commission

Industry Type/Nature of Business

Accommodation/Food Services
Administrative/Support Services
Education
Financial/Insurance Services

Employer/Business Name

Type of ID Submitted (at least one):

Relationship to Principal Applicant

Passport

Drivers License

Voters ID

TIN ID

Nationality
Filipino

Separated

ZIP Code

Length of Stay (years/months)

ZIP Code

Length of Stay (years/months)

E-mail Address

Government
Information and Communication
Manufacturing
Transportation/Warehousing

SSS ID

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/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 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.

Principal Card Applicants Signature / Date

Supplementary 1 Card Applicants Signature / Date

Supplementary 2 Card Applicants Signature / Date

Please submit/mail complete application form and requirements to: China Banking Corporation Credit Card Division 5/F Philcom Bldg,. Paseo de Roxas, Makati City 1226