A4 - ATM Debit Card Form

CIF Number
(for internal use)

I. NEW ATM DEBIT CARD ACCOUNT INFORMATION

Do you want a Debit Card with your name on it? (If yes, provide the name to appear on the card) Yes No

II. EXISTING ATM DEBIT CARD UPDATE INFORMATION

To maintain your ATM Debit Card account, provide the card number

What would you like to do with the ATM Debit Card account indicated?

Add Account/s Remove Account/s Delete Card

(Provide account numbers to be added) (Provide account numbers to be removed)

CUSTOMER UNDERTAKING ATM DEBIT CARD RECEIVED BY

By signing, I hereby certify that the information in this form is true and correct to the best of my knowledge. By signing, I / We confirm that I / We have received our ATM Debit Card.
I undertake to advise BDO Group and provide documentation for any changes to the above information.

Signature over Printed Name Signature over Printed Name

Date Signed Date Signed

(mm / dd / yyyy) (mm / dd / yyyy)

/ / / /

Account Name Account Number

Branch Card Number (for new cards)

FOR I NT E RN A L U S E O NLY

Date (mm/dd/yyyy)

/ /

Card Type (If ‘Others’, please indicate) Verified and Card Released by
Name / Signature Date (mm/dd/yyyy)

Mastercard Junior Savers Prime Savers

/ /
Visa Kabayan Savings Others

Verified and Processed by Approved by Witnessed by

Name / Signature Date (mm/dd/yyyy) Name / Signature Date (mm/dd/yyyy) Name / Signature Date (mm/dd/yyyy)

/ / / / / /

BDO Unibank, Inc. is regulated by the Bangko Sentral ng Pilipinas.

Tel. No.: (02) 8708-7087; Email: consumeraffairs@bsp.gov.ph. REVISED AS OF MAY 2022
The BDO, BDO Unibank, and other BDO-related trademarks are owned by BDO Unibank, Inc.