BPI SUPPLEMENTARY CARD REQUEST FORM_DRAFT 1

DECLARATION

SIGNATURE

DATE

For inquiries and comments, please send us a message through www.bpi.com.ph/contactus or call

our 24-hour BPI Contact Center at (+632) 889-10000.

Bank of the Philippine Islands is regulated by Bangko Sentral ng Pilipinas. https://www.bsp.gov.ph.

The information contained in this form is accurate as of printing date (08/2021) and is subject to

change after such date.

PRINCIPAL CARDHOLDER

SUPPLEMENTARY CARDHOLDER

All the statements, information and supporting documents provided by me (us) are true, correct, and accurate.

Any material misrepresentations or falsity or omission herein which is misleading shall be construed as an act to defraud Bank of

the

Philippine Islands (“BPI”) and may be a ground for the denial of my (our) application or, if already granted, the cancellation or

termination

thereof, including rendering any loans granted to me (us) immediately due and payable, without prejudice to such civil and/or criminal

liability

action that BPI may pursue against me (us).

It is the sole prerogative of BPI to grant or deny my (our) application and should my (our) application be denied, BPI may provide the

reason

for such decision in accordance with the requirements of applicable law.

All information and documents obtained, collected and processed by BPI in connection with my (our) application shall remain the

property

of BPI.

as they may deem necessary or appropriate in connection with my (our) availment of any of their products, services, facilities and

channels.

My/Our application, enrollment, availment, access, maintenance and continued use of any of the products, services, facilities and

channels

of any member of BPI Group of Companies shall constitute my/our acceptance and agreement to the applicable terms and conditions.

I (We) shall notify BPI of any material changes affecting the information supplied by me/us and documents submitted in connection with

this

application.

I (We) agree to receive updates, notices and announcements on my (our) application and/or any of BPI’s products, services, facilities

and

channels via SMS/text, email or fax transmission or such other means of communication deemed appropriate by BPI.

Where applicable, BPI may enroll my (our) approved application with any credit protection provider, or guarantee program of any

institution,

whether public or private, at BPI’s sole option.

Prior to submitting to BPI information about individuals (including their personal data), I (we) have obtained all necessary authorizations

and

further agree that all my (our) personal information (including those of individuals related to me(us), my (our) transactions, business

and

credit relationships, accounts or account information or records which are with you, made available to you or which are in your

possession

disclosed, by and between BPI and any member of the BPI Group of Companies, their successors and assigns, and their

respective

authorized representatives, agents and service providers, for any or all the purposes described in the Data Privacy Statement published

https://online.bpi.com.ph and deemed incorporated by reference in this form.

10.

I (we) have read, understood and agree to be bound by BPI’s “Terms and Conditions of the Deposits, Products, Services, Facilities

and

Channels”, as well as BPI’s “Terms and Conditions Governing the Issuance and Use of BPI Credit Cards”, as these terms and

conditions

may be amended or supplemented from time to time, copies of which were either provided to me (us) or made available /accessible to

(us) via www.bpi.com.ph or such other channels or electronic applications selected by BPI.

1. The foregoing shall apply to all products, services, facilities and channels of BPI that I (we) may now or hereafter apply for or avail of.

REQUIREMENTS FOR NEW SUPPLEMENTARY CARDHOLDER/S

NEW

KINDLY CHECK AS APPLICABLE

SUPPLEMENTARY CARD REQUEST FORM

EXISTING and for updating of information

1. Must be at least thirteen (13) years old upon submission of the form and requirements.

2. Must provide a copy of a valid and unexpired photo-bearing ID.

3. Properly filled out request form with signature of both principal cardholder and nominated supplementary cardholder.

PRINCIPAL CARDHOLDER INFORMATION

Name

SUPPLEMENTARY CARDHOLDER INFORMATION

Membership fee for the first supplementary cardholder is FREE FOR LIFE.

Name

Last, First, Middle

Email Address

Card Number

Office/Business Phone Number/LocalHome Phone Number (if provincial include Area Code) Mobile Number

6 3 9

Office/Business Phone Number/LocalHome Phone Number (if provincial include Area Code)

Mobile Number

6 3 9

Civil Status

Nationality

Sex

Male Female

Single Married Separated Widowed

Credit Limit Assigned to Supplementary Cardholder

100% of Principal’s Credit Limit Others: PhP

Card Number (For Existing Supplementary Cardholder)

Email Address

Birthdate (mm/dd/yyyy)

Place of Birth

Nature of Business/Industry Source of Funds

(Salary, Business, Remittance, Pension, etc.)

Last, First, Middle

(Zip Code)

Home Address

(House/Unit No., Floor, Building Name)

(Street Name, Village, Barangay)

(Municipality / City / Province)

Employer / Business Name

SSS Number / GSIS Number

Relationship to Principal Cardholder

T.I.N.

(Tax Identification Number)