BPI CREDIT CARD APPLICATION CONFORME

This is to confirm that I have submitted a physical copy of my BPI credit card application form, and have
submitted a copy of the following documents as part of the application requirements:

SUBMITTED DOCUMENT FORM

REQUIREMENT
(Please specify type) (Please put an "x")
ID Physical copy Digital copy
Income document/s Physical copy Digital copy

Credit card type/s chosen (please put an “x”):

BPI Signature Card Petron BPI Card

BPI Platinum Rewards Card BPI Amore Cashback
BPI Amore Platinum Cashback BPI Rewards Card
BPI Gold Rewards Card BPI Edge Card

I also hereby confirm that the following:

YES NO

1. The features and benefits of my chosen card/s were clearly discussed and
explained to me by the sales agent whose name and agency affiliation appears
below.

2. I was informed that the annual membership fee is free only for the first year.
3. I applied for and was solely offered a BPI credit card.

By signing this form, I agree to the collection, use, and storage of my ID and its details via image capture
as a documentary requirement for my BPI credit card application alone.

__________________________________ __________________________________

Applicant’s Name and Signature Agent’s Name and Signature

__________________________________ __________________________________

Date and Location Agency Name