PNB CARDS APPLICATION FORM

Check your preferred PNB Credit Card: r

PNB Mastercard PNB Visa
PNB-PAL Mabuhay Miles Mastercard PNB-Travel Club Platinum Mastercard

Scan the accomplished and signed form and send PNB UnionPay* Others:
via email to PNBCreditCards@pnb.com.ph. You Single Currency Dual Currency

may also submit this form at any PNB branch. *If no selection is made, default is single currency.

1. PERSONAL INFORMATION (BSP-REQUIRED)

First Name Middle Name Last Name

Date of Birth Place of Birth Gender Education Mother’s Full Maiden Name No. of dependents:
mm dd yyyy Male High School College
Female Some College Graduate School

Present Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City) Nationality/Country of Citizenship Status

Filipino Non-Filipino Single Separated

(state country of citizenship)
(Province/Region, Country) ZIP Code Years of Stay Married Widow

Choose one and provide the number

SSS GSIS TIN Email
Is permanent residence address the same as present residence address? Yes No (please provide permanent
residence address below)
Permanent Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)

Home Landline Number Mobile Number

(Province/Region, Country) ZIP Code

With current relationship with PNB? Yes No

Home Ownership
Owned Rented P ____________________ Others _________________________ PNB Account Number: ______________________________________________________________
Living with Relatives Mortgage P ____________________ PNB Branch: ______________________________________________________________________

If you are a foreign national, you must submit a photocopy of any of the following:

1. ACR / ICR or I-Card 2. Philippine Retirement Authority ID And ANY of the following (check submitted I.D. / document)
I.D. No. __________________________________ Passport with ACR Internal Revenue Service I.D. (IRS I.D.) SSS I.D.
Expiry __________________________________ National I.D. Work Permit Issued by DOLE (Mandatory if employed in the Philippines)

2. NATURE OF WORK / SELF-EMPLOYMENT / BUSINESS (BSP-REQUIRED) 3. SOURCE OF FUNDS/INCOME (BSP-REQUIRED)

You may check more than one:
Employed Self-employed/Practicing Profession Own Business
Salary Ave. Monthly Amount:
Private Nature of Work/Profession/Business (Based on SEC/DTI/Business Permit):
Business Revenue Ave. Monthly Amount:
Public
Commission Ave. Monthly Amount:
Name of Employer/Business Position/Rank No. of years with the firm Professional Fees Ave. Monthly Amount:
Savings / Deposit /
Investments Ave. Daily Balance:
Employer/Business Address (Unit #, Bldg./House #, Street, Barangay/District, Pension Ave. Monthly Amount:
City, Province/Region, Country) ZIP Code Employer Contact Number
Remittance Remitter Name:
Relationship with Applicant:
Country Origin of Remittance:
No. of years with
Previous Employer Position/Rank previous employer Ave. Monthly Amount:
Others (Pls.specify): Type and amount:

4. NON-PNB CREDIT CARDS (at least one year principal ownership)

Credit Card Company Card Number Credit Limit

5. SPOUSE INFORMATION
First Name Middle Name Last Name Mother’s Full Maiden Name Date of Birth Citizenship
mm dd yyyy Filipino
Non-Filipino:
____________

Business / Company Address (Number, Street, District, City/Province) Office Tel. No. Employment Status Mobile Number
Employed Unemployed
Self-employed

6. MABUHAY MILES MEMBERSHIP

Provide your Mabuhay Miles number in order to enjoy the conversion of earned rewards points to Mabuhay Miles. If you do not have a Mabuhay Miles Account yet, you may get one by
enrolling online at www.mabuhaymiles.com.

Are you a current member of Mabuhay Miles? Yes No If yes, please indicate your existing Mabuhay Miles membership number:

7. BILLING INFORMATION 8. SUPPLEMENTARY CARD (must be at least 13 years old) - LIFETIME ANNUAL FEE WAIVER
Choose where you want your BILLING STATEMENT to be delivered: First Name Middle Name Last Name
Email Home Office
If Email is chosen, please choose where your CARD will be delivered:
Date of Birth Gender Status Mother’s Full Maiden Name
Home Office mm dd yyyy
Male Single Separated
Automatic Debit Arrangement (ADA) from your PNB or PNB Savings Female Married Widow
Checking or Savings Account
If you want to pay via ADA from your PNB CASA, please fill out below: Relationship with principal applicant Email Address
PNB PNB Savings
Auto Debit my PNB Peso acct. # Mobile Number Sub-limit*
Full Minimum
Auto Debit my PNB Dollar acct. #
*For Sub-limit: Principal cardholder assigns the sub-limit. Specify the amount, Signature
Full Minimum rounded off to the nearest thousand. If not specified, the default sub-limit is 100%.
(For Auto Debit, if selection is not checked, payment will automatically be minimum.)
9. DECLARATION
By signing below, I/we are applying for a PNB Credit Card. I/We agree to abide by and be governed by the Terms and Conditions governing the issuance and use of the PNB Credit Card and all future amendments thereto. I/We authorize
Philippine National Bank (PNB) to verify the information in this application and to receive and exchange information about me/us, including requesting reports from PNB's consumer credit reporting or reference or other accredited bureaus.
I/We hereby acknowledge and authorize: 1) the regular submission and disclosure of my basic credit data (as defined under R.A. 9510 and its Implementing Rules and Regulations) to the Credit Information Corporation (CIC) as well as any
updates or corrections thereof; and 2) the sharing of my basic credit data with other lenders authorized by the CIC, and credit reporting agencies duly accredited by the CIC. I/We also authorize PNB and their affiliates to contact these
sources for information at any time, to use information about me/us, including information from this application and from consumer credit reports, for marketing and administrative purposes and to share such information with each other.

By signing up for this product and/or service, I/we authorize PNB, their branches, subsidiaries, affiliates, representatives, and their authorized third party service providers to collect, use, and disclose my/our personal data and share such
data for marketing and promotional purposes such as, but not limited to, calls, emails, and/or SMS. I/We may withdraw such consent at anytime by calling the PNB Cards Customer Service or sending a notification via mail or email to PNB.

I/We hereby agree to waive my/our right/s regarding the confidentiality of deposits under R.A. 1405, as amended, as the disclosure is necessary and relevant in the evaluation of my/our application for a PNB Credit Card and to ensure a
successful debit under an auto-debit payment arrangement with my/our PNB/PNB Savings account should I/we decide to avail of the auto-debit payment facility to my/our PNB Credit Card. I/We hereby authorize the bank, in the event
that my account becomes past due, to offset against my deposit, any unpaid balances or endorse my account to an accredited third party agency, and subsequently cancel my card. I/We further authorize and consent to the Philippine
National Bank to be the recipient of these information and to conduct random verification with the BIR in order to establish authenticity of the Income Tax Return (ITR).

I/We hold ourselves, jointly and severally liable for all obligations and liabilities arising from the use of the PNB Credit Card and supplementary card/s and, in the the event that my/our application for a PNB Credit Card is disapproved, the
Philippine National Bank is under no obligation to provide me/us with the reason for such a decision.

The accomplished application form and requirement/s submitted will become the property of the Philippine National Bank. The Philippine National Bank is under no obligation to return the said documents.

All PNB Credit Cards are issued for personal use only. Should PNB find that my/our transactions are relatively higher than the usual personal consumption, PNB has the right to cancel or revoke the credit card immediately.

Further hereby declare, that in compliance with BSP Circular No. 472, I agree to send a copy of my latest duly-stamped ITR or BIR Form 2316; or latest 3 months payslips, if employed; or Audited Financial Statements, if self-employed.

FOR BANK USE ONLY

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Souce Code Source C

Program Name/Code: Branch/Channel Code:

Employee No.:

Solicitor’s Name: CRR Code:

Signature of Principal Applicant Date
PNB is regulated by the Bangko Sentral ng Pilipinas. OPAF_OMNI_AUGUST2017
BSP contact details: (02) 708-7087 / consumeraffairs@bsp.gov.ph