LANDBANK OF THE PHILIPPINES

CREDIT CARD ADMINISTRATION DEPARTMENT

CARHOLDER REQUEST FORM

INCREASE OF CREDIT LIMIT TO P ________________ / $ ________________

I understand that my approved credit limit shall be applicable to my credit account, including its
extension.

EXTENSION CARD

Name: _____________________ Relationship: __________________ Birth Date: ___/___/___

I understand that, if issued, the extension card will bear a different card number. Nevertheless,
in all cases, all purchases/transactions made through the use of the extension card will be billed
to me.
The extension cardholder has read and understood the terms and conditions set forth in my
signed application form and agree to use his/her extension card accordingly. He/she agrees to
be held jointly and severally liable with me for payment of obligations under the
application/agreement.

SIGNATURE OF EXTENSION _________________________

VISA UPGRADE

Gold International
Classic
InternationalGold

PLDT CHARGE PAYMENT

Subscriber Name : ______________________________
Telephone No. : ______________________________
PLDT Account No. : ______________________________
(Please attach copy of your latest PLDT billing statement)

MERALCO CHARGE PAYMENT

Subscriber Name : ______________________________
Res. Address : ______________________________
Res. Account No. : ______________________________
Meter No. : ______________________________
(Please attach copy of your latest MERALCO billing statement)

REPLACEMENT CARD

Spoiled Card
Lost Card
Change Name

Please attach affidavit of loss Please attach proof of change in status

CHANGE OF ADDRESS / PHONE NO.

Please change my billing address to:
Office
Home
New Phone No. : ___________________ _____________________________
_____________________________
_____________________________
SIGNATURE : _____________________________
CARDHOLDER NAME : _____________________________
CARD NUMBER : _____________________________
Please send original copy to LANDBANK VISA 28th Floor LANDBANK PLAZA 1598 M.H. Del Pilar cor.
Dr. J. Quintos St. Malate, Manila 1004