WHOLESALE INDIVIDUAL APPLICATION FORM

Program Branch Wholesale - Private Branch Wholesale - Government FOS Wholesale - Private * FOS Wholesale - Government Others

MY PERSONAL DATA
My Choice of Metrobank * Classic Visa / MasterCard M Free MasterCard (HRP) If we cannot process your request for your chosen * YES: NO
Card Metrobank Card, would you accept another card type?
please specify
Card Company 16-digit Card Number Credit Limit Member Since
My Other MCC Card Info
Card Company 16-digit Card Number Credit Limit Member Since

My Other Credit Card Info

Last Name Given Name Middle Name

Applicant Name Longakit Jay Ruel Sarona

MM DD YYYY
7 3 ### * Single Widowed Gender * Male Female
Civil
Date of Birth
Status Married Separated Nationality * Filipino Others: _______________
Place of Birth (Foreigners, attach ACR or ICR)
Last Name Given Name Middle Name MM DD YYYY
Name of Spouse Block Date of Spouse's
(If applicable) 25 Birth (If applicable)
Lot
Mobile Phone Number 1 ### Home Phone Number 1
26
Mobile Phone Number 2 Deut
### Home Phone Number 2
eron
Email Address Krisjhay2503@gmail.com Mother's Maiden Name
omy
Stree
Present Home Address t,
8000
Emily
Hom
Permanent Home Address
(If Different from Present Home Address) es,
Zip Code: ________
Caba
Home Ownership ntian Owned Rented Mortgaged * Living with Parents Length of Stay: _______________________________
,
Education Dava
* College High School Some College Post Graduate Vocational
o
Tax Identification Number City SSS or GSIS Number

Source Of Funds * Employment * Investments Retired (Pension, etc) Self Employment / Business Others: ____________________________

Company Name RM LED Lights Corporation Nature of Business Lights

Sales Agent Office Phone Office Phone

Level / Position Local: ________ Local: ________
Number 1 Number 2

Business Address Km 10 Plain View Village Sasa Davao City Zip Code: ________
MM DD YYYY
Total Years
Working 1 YEAR * Regular Project Based
5 15 2016 Employment
Date of Hire
Gross Annual 11,500 Status Probationary Contractual
Years with present employer
Income
MY SUPPLEMENTARY DELIVERY INSTRUCTIONS
Supplementary Cardholder must be 14 to 80 years old. Supplementary card applicants are required to submit a photocopy of a valid government-
DELIVER CARD &
issued ID and complete the fields marked (*). The spending limit given to the Supplementary Cardholder is part of the Principals credit limit. If the
STATEMENT TO: * Home Business
spending limit indicated is greater than the approved credit limit, the spending limit to be given to the Supplementary Cardholder will be the same as
(choose one)
the approved credit limit.
Last Name Given Name Middle Name No
Is this a condominum? Yes
Supplementary Name Longakit Emersilly Sarona
I want to receive my
Yes Email:
statements via Email
Home Address
Block 25 Zip Code: ____8000____
Lot M26M DD YYYY
Deutero
Relation to
PREFERRED PAYMENT METHOD
nomy 3 16 1974
Date of Birth Street, Principal Mother I will pay in cash or check at a Metrobank branch/PSBank branch/other payment channels
*
Emily Applicant
Homes, Place of Birth
Cabanti
Gender an, Male * Female Nationality Filipino Automatic Debit Arrangement (ADA)
Davao
City Home Phone Please debit my Peso current/savings account no: ______________________________
Mobile Phone Number
Number at Metrobank __________________________________________________ branch.
Assigned Monthly 100% of Principal's Credit Limit Php: Minimum Amount Due
Spending
Tax Identification SSS or GSIS Full Amount Due
Number Number
UNDERTAKING
I would like to avail of the Metrobank Credit Card offered under the Metrobank Card Corporation's Wholesale Program. I hereby authorize my employer to provide /confirm to Metrobank Card Corporation my information necessary to facilitate my credit card
application. In the event of approval of my application for the Metrobank Credit Card, I hereby agree to be governed by the TERMS AND CONDITIONS (made an integral part of this undertaking) of the use of the Metrobank Credit Card which mayl be issued to
me and which I may receive, as evidenced by my signature hereof, and/or the signature of my representative. My use of the card shall constitute proof that I have read and fully understood the TERMS AND CONDITIONS enclosed and delivered with the card
and that I consent to be bound under such. I agree, further, to hold MCC card and harmless from any and all liabilities that I will incur with the use of the Metrobank Credit Card. I further hold myself liable for all obligations andliabilities that I will incur with the
use of the Metrobank Credit Card which may be issued to me.
DECLARATION
I/We hold myself/ourselves liable for all obligations and liabilities incurred with the use of the Metrobank Credit Card/s issued to me/us. I/We warrant that, I/We shall be jointly and severally liable for the same obligations and that I/we hereby commit
myself/ourselves to the following declarations: (1) I/we certify that the foregoing facts are true and correct; (2) I/we authorize METROBANK CARD CORPORATION (A FINANCE COMPANY)[MCC] to receive and exchange any and all information concerning
myself/ourselves with other financial institutions, entities tasked to provide consumer credit reporting or reference schemes, the appropriate government agencies and third parties to whom MCC may reasonably share such information; (3) I/we authorize MCC, to
acquire any information from Metrobank and PSBank to facilitate the approval of my credit card application as well as all credit card transactions, e.g., cash advance, increase in credit limit, etc. initiated upon my/our own initiative and in the event of default
arising from non-payment of credit card obligations with MCC; (4) I/we authorize MCC, its authorized representative/s and/or agent/s to verify and investigate these facts from whatever source it deems appropriate; (5) I/we understand that should my/our credit
card application be denied, MCC has no obligation on its part to furnish the reason for such rejection except when the denial is based on credit data from CIC used in the evaluation of my/our application; (6) I/we agree that by calling MCC or any of its service
providers, MCC or its service providers may, at its sole option and discretion, tape or record all my/our telephone communications. I/We likewise agree that such taped or recorded communications or transactions may be used by MCC or its service provider
against me/us or any third party, replayed or communicated to any third party, for any purpose, including as evidence in any proceeding; and (7) I/we agree to the TERMS AND CONDITIONS governing the issuance of Metrobank Credit Card. This further serves
as a waiver of confidentiality of all personal information that I/we have provided and authorizes MCC to conduct random verification with the BIR in order to establish authenticity of my ITR and the accompanying financial statements I submitted.

Signature of Applicant Date

TABLE OF FEES AND RATES Classic Mastercard / Visa M Free Mastercard ON Internet MasterCard

* YES! I Want a Metrobank ON Internet MasterCard Annual Fee Php 1,500 / Php 800 Perpetually Waived Php 500 / Php 250
Principal / Supplementary Waived on 1st Year Waived on 1st Year
Email Address: Mobile Number: Retail Monthly Effective Rate 3.54% based on actual calendar days.
The Metrobank ON Internet Mastercard is the credit card for all your intenet Cash Advance Monthly Effective Interest PHP600 or 3% of the cash amount availed, whichever is higher. Not applicable
transactions. This card enables you to shop more securely online. It is designed for Rate Additional PHP500 if transacted over-the-counter.
non face-to-face transactions, giving you greater security and peace of mind.
Cash Advance Fee
PHP600 or 3% of the cash amount availed, whichever is higher. Not applicable
Additional PHP500 if transacted over-the-counter.

Online Security
Late Payment Fee PHP 750 or 7.5% of the minimum amount due, whichever is higher.
Your Metrobank ON Internet MasterCard is a more secure payment solution for all Over Credit Limit Fee PHP700 (M Free) / PHP500 (Classic, ON) per occurrence.
your internet transactions. It is automatically enrolled to Secure Online Shopping PHP200 or an amount equivalent to the credit balance, whichever is lower will be charged to
One Time (SOS-OTP) which means that when you use your Metrobank ON Internet Account Maintenance Fee
accounts with credit balance that are closed or with no activity for the past 12 months.
MasterCard at participating online merchants, you will receive a SOS-OTP on your
mobile phone. Installment Pre-Termination Fee 5% of the remaining principal balance or P500 whichever is higher. Not applicable

Gaming Fee 5% of the amount transacted.

Paperless Statements
Receive your monthly statement of account via your nominated email address. Statement Reprinting Fee P100 per request for reprinting and delivery of monthly statement.

ON Rewards Program Returned Check Fee PHP1,500 for every returned check.
Earn rewards points each time you use your Metrobank ON Internet MasterCard.
Earn one (1) point for every P 20 you spend on your card which you can Multiple Payment Fee P50 for each payment made to Metrobank Card in excess of two (2) within a calendar month.
accumulate and use to redeem online shopping credits. Every 10,100 points is
equivalent to P 500 shopping credits. Cash2Go Processing Fee P100 will be charged for every Cash2Go transaction. Not applicable

Balance Conversion
Processing Fee P100 will be charged for every Balance Conversion transaction. Not applicable

All charges, advances or amounts in currencies other than Philippine Peso (Php) shall be converted to
Php based on MasterCard's / VISA's currency conversion rate at the time of posting and charged
Signature of Applicant Date MasterCard's / VISA's assessment fee plus 2.50% processing fee, the rate of which may be adjusted
Foreign Currency Transactions from time to time. The assessment fee shall likewise apply to transactions involving foreign currencies
converted to Php at point of sale, whether executed in the Philippines, abroad or online. Service fees
may also be charged to cover costs incurred to discharge the amount(s) due to MasterCard / VISA
and / or the acquiring bank and / or foreign merchant affiliates.