Application Form PNB 1 3 PDF

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Summary

Sources on the study of medical aspects of law and legal aspects of medicine. Legal medicine is the
application of medical and paramedical scientific knowledge to certain branches of law, both civil and
criminal. Its aim is to aid the administration of justice by correlating such knowl...

Description

PNB CREDIT CARD APPLICATION FORM Check your preferred PNB Credit Card: PNB MasterCard

PNB-The Travel Club Platinum MasterCard

PNB-PAL Mabuhay Miles MasterCard

Other PNB Cards:

Scan the accomplished and signed form and send it via email to [email protected] or fax to (02) 812-6247 / (02) 892-7427. You may also submit this form at any PNB branch.

PNB UnionPay PNB Visa

1. PERSONAL INFORMATION (BSP-REQUIRED) First Name

Middle Name

Date of Birth mm

Place of Birth

dd

Sex

Education Male Female

yyy y

Last Name

College

Some College

Graduate School

Present Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)

Nationality/Country of Citizenship Filipino

ZIP Code

(Province/Region, Country)

No. of dependents:

Mother’s Full Maiden Name

High School

Status

Non-Filipino (state country of citizenship)

Years of Stay

Single

Separated

Married

Widow

Choose one and provide the number Is permanent residence address the same as present residence address?

SSS

Yes

No (please provide permanent residence address below) Permanent Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)

GSIS

Email

TIN

Mobile Number

Home Landline Number (Province/Region, Country)

ZIP Code

With current relationship with PNB?

Home Ownership Owned

Rented

P ____________________

Living with Relatives

Mortgage

P ____________________

Yes

No

PNB Account Number: ______________________________________________________________

Others _________________________

PNB Branch: ______________________________________________________________________

If you are a foreign national, you must submit 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. __________________________________ Expiry __________________________________

Passport with ACR National I.D.

Internal Revenue Service I.D. (IRS I.D.) SSS I.D. Work Permit Issued by DOLE (Mandatory if employed in the Philippines)

3. SOURCE OF FUNDS/INCOME (BSP-REQUIRED)

2. NATURE OF WORK / SELF-EMPLOYMENT / BUSINESS (BSP-REQUIRED) Employed

Self-employed/Practicing Profession

Pri vate

You may check more than one: Salary Ave. Monthly Amount:

Own Business

Nature of Work/Profession/Business (Based on SEC/DTI/Business Permit):

Business Revenue Commission Professional Fees Savings / Deposit / Investments Pension Remittance

Pub li c

Name of Employer/Business

Position/Rank

Employer/Business Address (Unit #, Bldg./House #, Street, Barangay/District, City, Province/Region, Country)

Previous Employer

ZIP Code

Employer Contact Number

No. of years with previous employer

Position/Rank

Others:

Ave. Monthly Amount: Ave. Monthly Amount: Ave. Monthly Amount: Ave. Daily Balance: Ave. Monthly Amount: Remitter Name: Relationship with Applicant: Country Origin of Remittance: Ave. Monthly Amount: Please specify type and amount:

4. YOUR NON-PNB CREDIT CARDS (at least one year principal ownership) Cr edit Card Company

Card Number

Credit Limit

5. SPOUSE INFORMATION First Name

Middle Name

Mother’s Full Maiden Name

Last Name

Date of Birth mm

Employment Status Employed Self-employed

Business / Company Address (Number, Street, District, City/Province)

dd

Citizenship yyyy

Filipino Non-Filipino: ____________

Mobile Number Unemployed

6. MABUHAY MILES MEMBERSHIP Provide your Mabuhay Miles membership number in order to enjoy conversion of rewards points earned to Mabuhay Miles. A new Mabuhay Miles membership number will be auto-generated if the Mabuhay Miles membership number portion below is left blank or an invalid number is provided. No adjustments can be made afterwards. Are you a current member of Mabuhay Miles Club?

Yes

No

I f you are, please indicat e your existing Mabuhay Miles membership number:

8. SUPPLEMENTARY CARD (must be at least 13 years old) - LIFETIME ANNUAL FEE WAIVER

7. BILLING INFORMATION Choose where you want your BILLING STATEMENT to be delivered: Email Home Office If Email is chosen, please choose where your CARD will be delivered: Home

Office

First Name

Date of Birth mm

dd

Sex Ma le

(For Auto Debit, if selection is not checked, payment will aut omatically be minimum.)

Status

Mother’s Full Maiden Name

yyy y

Automatic Debit Arrangement (ADA) from your PNB Checking or Savings Account If you want to pay via ADA from your PNB CASA, please fill out below: Auto D ebit my PNB Peso acct . # Full Mini mum Auto Debit my PNB Dollar acct. # Full Minimu m

Last Name

Middle Name

F e ma le

Relationship wit h pr incipal applicant Mobile Number

Sin g le

Se p a ra te d

Ma rrie d

W id o w

Email Address * Sub-limit

*For Sub-limit: Principal cardholder assigns sub-limit. Specify amount rounded off to the nearest thousand.

Sig n a tu re

If not specified, default sub-limit is 100%.

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 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 CIC. I/We also authorized 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 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 Credit 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...