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sw.*inab.nk.ph $ilc* 19S CREDIT CARD APPLICATION

required filled-up. put
Principal Applicant's Name (Frirsfwaee MiddleName, LastNeBe, Suirx) E Mr. E Ms. E M6. E Dr. EAtty. E Engr. E-
N/A
rARY 1

Name (FiFtNare, rrrudre Nm, tz.g/'Name, sufrx) E Mr- E Ms. E Mre. E Dr. E Any. tr Ergr. E_ Gender
NA E Male E Female
Name to Appear on Catd (Maximum of 22 chaactqs inctuding spaces. Nicknames/Alias$ are not allowed.) | Date of Bidh (mm/dd/Wyy) Place ol BitTh (Cvcountry)

Highest Educational Atiainment Civll Status Nationality

E Hiqh School n Post-Graduate flUndergraduate E Single E Manied tr SpaEted E Divo@d E Widmed E Filipino E
I College tr
Mothefs Maiden Name (Fi6t Name, Middle Name, Last Nafre) Have you stayed in the United States of America (USA) for at U.S. Tax Account Numbet (if Ameri@n citizen)
leaat 183 consecutive days within the last three (3) yeaE?
EYES ENo
Home/Permanenl Addrss 1No, Strcet, Baqngay, District, City/Municipality, Ptovin@, Code) Length ot Stay (nonths/yeats)

PresentAddrss n Same as Home/Permanent Address Length ot Stay fmooths/years)

TIN SSSIGSIS No. Home Phone No, (lnclude Aea Coda) Mcbile Phore No. Personal E-mail Address

Employment Typs DesigoationlPositionlTitle Source(s) of Funds Maror lndustry of EmployerlcompahylBusaness

E Employed I Salary L] Allowances E A@mmodation/Food SeMces
E Govemment
E Self-Employed E Commission I Business El AdministEtiye/Support Seruies
E lnformation and communication
tr u E Education E Manufacturing
Employer/Company/Business Name Relationship to Pri!6ipal Applicant EFinancial/lnsuEnceSeMces ETransportationMarehousing
u
Type of lD submitted {at least ona): I Passport f] Driveis License E voteis lDf:J TIN lD E sss lD n
SUPPLEMENTARY 2
(First Nare, Middle NaM, Last Name. sufrix) E Mr. E Ms. D Mrs. O ,*r- fI _
frnflL" E Male E Female
Name io Appear on Card \nuinum of 22 chaacle6 ineluding spdw. Nqkiffis/Nfu,ses are not a.lbred.) | Dalc ol Bfulh (mnlddlyyyy) Place ol Bifih (city/countty)

I
Highest Educational Attainment Givil status
E HighSchool E Post-GEduate E Undergmduate
fl Single E Maried E Sepated fl Divorced E Widowed E Frtpino tl _---
E College tr
Mother's Maiden Name (F,ia, Nafle, Middle Name, Last Name) Have you staled in the Uniled States of Arerlca (USA) for U.S, Tax Account Number (if American citizen)
at le8t {83 consecutivs days vithin th. Iaet thrce (3}
YeaE? EYES flNo
Home/Pemanent Address fNo-, Street, Bazngay, District, CvA,lunicipaw Prcvin@, ZIP Code) Length of Stay {monrhY}are,
-
Presenl Address il Same as HomelPermanent Address Length ot Stay (months/yearc)

TIN SSS/GSIS No. Home Phone No. (lnclude Arca code) Mobile Phon6 No. Personal E.mail Address

Employmert Type Desi gnation/PositioniTitle

E Employed E Salary E Allowanem E A$ommodatiorvFood Soryices E Gremmnt
E n commission ll AdministEtivdsupport SeMces
tr_ Self-Employed
n
Business E
EEducation
E lnfornalion and Communicalion
EManufacturing
Employer/Company/Business Name Relationship tq Principal Applicant EFinancial/lnsumncoSeruices ETEns@riation/Warhousing
n
oflDSubmittedfatbastone): EPassport EDriver'sLi@nse EVotefslD flTlNlD ESSSID E
Creditsale is a credfi @rd insu@n@ that gives added peae of mind and s@rity to you and your family if you're {a@d with life's uncertainties. lt pays for 3 tilffi
your China Bahk Credit Card's indebtednss or PHP600,O00, whichever is lowel in the event of untimely death, total and pemaneni disability or first diagncis of
sitical iUness. lt d$ gives additionai prctectlon in ca*s of aEidgnid death and dismembement and tempery disablemnt
BENEFITS OF CREDITSAFE ARE AS FOLI OWS: BENEFICIARY DESIGNATION
KEY BENEFITS DESCRIPNON BEflEFICIARY DAIE OF BIRTH BENEFICIARY'S RELATIONSHIP TO CAROHOLDER
CredfrSafe pays fie bank an amounl {ual to 3 tm6 you. China Ba*
Credit Cds indebtedBss up b a maximum benefit of PHPCm,000 in
Death, Tobl & Psmanent
@se of loss of lfe, permaneni disablement or flret diag@;6 of @vered

tf l@ b due to acddantal dbmembgmr( CEd[6!ie prwk 6 yd ah

Accidenbl Dedh &
Dismembemeni &nefr
addilimd ber6 d your berefciary (ia @ oI a6*ira, derlh,) in
amodane b a sqific d.hedule.
ln case of tmporary disabiemeni of more than frirty {30) days, Crditsafe
TemFrary Disability
of dbablement up to * (6) nonth6, sfrng d fre 316t day of tempmry
di*blemnl Premiums du on lhe insuEne illl ds b waiwd shdiru
on he 3lstdavfora hdmum of six f6) Mhs.
of Trustes to Minor Eeneliciary
The mthly premium that will b .harged to you. China Eank Cedit Ca.d is 0.69% of yod erd's
outstanding balanG, induding any unbi{od installmont amunt

E Ye9! I mdd like my Chha Bank Crcdit Card to b6 @wred undcr Ccditsafe ttEt wl pay otr rV
cEdit @rd bills in @6e of deah, dlsbility, o fiEt dhgrcsis of @Gd qitiel illree

OPTIONAL ENROLLMENT TO CREDITSAFE

hncfis d CredilSale, I dedaB ed ag@ lhat:
lo awting lhe
Tb @@ appndiq fom ad any aMmed b it i9 mdeb and Ne b he H of nry knflledge qnd bdbf.
ln my
I m bM 18& y*6 d, h good haft ahd how etu ben h6r*bliued M @bd for &y ill@,in lra pdd tud6 (i2) @$a I gOE6 b bs bouod by e{ o0s m sfld esdIirc cf t}D pof,q ffi* lo b6 }sud.
I m arduDing clnna gnk b co[d and @ ttE hflir didoqed in my fne Ba* cl8di Cad Apdicalim fom, tagptd {,ith ey $bs6q@t dEr6 b it @Xocted by tE Bank, to 6rr & ib bus}E I em ako g6ding
ChaM Eank lhe dthority to h6fer $ch inlonnalio b its eiatedlo@i6, bosiErytuB, effliaE, advis, rpG6iatiE ard any *ryice p.wus fo. arry legitimb porFoe.
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rhe featurE and """*
hdre oICdiLSde and tbt ho @re|[onolm prHlrdwfi OeMmeDLmv dnina eank Creoil &d a@nt.
Principal Applicaf,t's Name and Signaturc
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You may also send lt via Fax (443-368'll or Ef,ail (c.rdsalss@chinabankph)