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PNB CREDIT CARD APPLICATION FORM

Check your preferred PNB Credit Card:


PNB MasterCard

PNB-The Travel Club Platinum MasterCard

PNB-PAL Mabuhay Miles MasterCard

Other PNB Cards:

Scan the accomplished and signed form and send it via email to
PNBCreditCards@pnb.com.ph or fax to (02) 812-6247 /
(02) 892-7427. You may also submit this form at any PNB branch.

PNB UnionPay
PNB Visa

1. PERSONAL INFORMATION (BSP-REQUIRED)


First Name

Middle Name

Date of Birth
mm

Place of Birth

dd

Sex

Education
Male
Female

yyyy

Last Name

College

Some College

Graduate School

Present Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)

Nationality/Country of Citizenship
Filipino

ZIP Code

(Province/Region, Country)

No. of dependents:

Mothers Full Maiden Name

High School

Status

Non-Filipino
(state country of citizenship)

Years of Stay

Single

Separated

Married

Widow

Choose one and provide the number


Is permanent residence address the same as present residence address?

Yes

Permanent Residence Address (Unit #, Bldg./House #, Street, Barangay/District, City)

SSS

No (please provide permanent


residence address below)

GSIS

Email

TIN

Mobile Number

Home Landline Number


(Province/Region, Country)

ZIP Code
With current relationship with PNB?

Home Ownership
Owned

Rented

P ____________________

Living with Relatives

Mortgage

P ____________________

Yes

No

PNB Account Number: ______________________________________________________________

Others _________________________

PNB Branch: ______________________________________________________________________

If you are a foreign national, you must submit photocopy of any of the following:
1. ACR / ICR or I-Card

2. Philippine Retirement Authority ID

And ANY of the following (check submitted I.D. / document)


Internal Revenue Service I.D. (IRS I.D.)
SSS I.D.
Work Permit Issued by DOLE (Mandatory if employed in the Philippines)

Passport with ACR


National I.D.

I.D. No. __________________________________


Expiry __________________________________

3. SOURCE OF FUNDS/INCOME (BSP-REQUIRED)

2. NATURE OF WORK / SELF-EMPLOYMENT / BUSINESS (BSP-REQUIRED)


Employed
Private

You may check more than one:

Own Business

Self-employed/Practicing Profession

Nature of Work/Profession/Business (Based on SEC/DTI/Business Permit):

Public

Name of Employer/Business

Position/Rank

Employer/Business Address (Unit #, Bldg./House #, Street, Barangay/District,


City, Province/Region, Country)

Previous Employer

ZIP Code

Employer Contact Number

No. of years with


previous employer

Position/Rank

Salary
Business Revenue

Ave. Monthly Amount:


Ave. Monthly Amount:

Commission
Professional Fees
Savings / Deposit /
Investments
Pension
Remittance

Ave. Monthly Amount:


Ave. Monthly Amount:
Ave. Daily Balance:
Ave. Monthly Amount:
Remitter Name:
Relationship with Applicant:
Country Origin of Remittance:
Ave. Monthly Amount:
Please specify type and amount:

Others:

4. YOUR NON-PNB CREDIT CARDS (at least one year principal ownership)
Credit Card Company

Card Number

Credit Limit

5. SPOUSE INFORMATION
First Name

Middle Name

Mothers Full Maiden Name

Last Name

Employment Status
Employed
Self-employed

Business / Company Address (Number, Street, District, City/Province)

Date of Birth
mm

Unemployed

dd

yyyy

Citizenship
Filipino
Non-Filipino:
____________

Mobile Number

6. MABUHAY MILES MEMBERSHIP


Provide your Mabuhay Miles membership number in order to enjoy conversion of rewards points earned to Mabuhay Miles. A new Mabuhay Miles membership number will be auto-generated if the
Mabuhay Miles membership number portion below is left blank or an invalid number is provided. No adjustments can be made afterwards.
Are you a current member of Mabuhay Miles Club?

Yes

No

If you are, please indicate your existing Mabuhay Miles membership number:

8. SUPPLEMENTARY CARD (must be at least 13 years old) - LIFETIME ANNUAL FEE WAIVER

7. BILLING INFORMATION
Choose where you want your BILLING STATEMENT to be delivered:
Email
Home
Office
If Email is chosen, please choose where your CARD will be delivered:
Home
Office

Date of Birth
mm
dd

yyyy

Sex

Auto Debit my PNB Peso acct. #


Auto Debit my PNB Dollar acct. #

Full

Minimum

Full

Minimum

(For Auto Debit, if selection is not checked, payment will automatically be minimum.)

Status

Relationship with principal applicant


Mobile Number

Mothers Full Maiden Name

Single
Married

Male
Female

Automatic Debit Arrangement (ADA) from your PNB Checking or


Savings Account
If you want to pay via ADA from your PNB CASA, please fill out below:

Last Name

Middle Name

First Name

Separated
Widow

Email Address
* Sub-limit

*For Sub-limit: Principal cardholder assigns sub-limit. Specify amount rounded off to the nearest thousand.
If not specified, default sub-limit is 100%.

Signature

9. DECLARATION
By signing below, I/we are applying for a PNB Credit Card. I/We agree to abide by and be governed by the Terms and Conditions governing the issuance and use of the PNB Credit Card and all future amendments thereto.
I/We authorize Philippine National Bank (PNB) to verify the information in this application and to receive and exchange information about me/us including requesting reports from PNB's consumer credit reporting or
reference or other accredited bureaus. I hereby acknowledge and authorize: 1) the regular submission and disclosure of my basic credit data (as defined under R.A. 9510 and its Implementing Rules and Regulations) to
the Credit Information Corporation (CIC) as well as any updates or corrections thereof; and 2) the sharing of my basic credit data with other lenders authorized by the CIC, and credit reporting agencies duly accredited by
CIC. I/We also authorized PNB and their affiliates to contact these sources for information at any time, to use information about me/us, including information from this application and from consumer credit reports, for
marketing and administrative purposes and to share such information with each other.
By signing up for this product and/or service, I/we authorize PNB, their branches, subsidiaries, affiliates, representatives, and their authorized third party service providers to collect, use, and disclose my personal data and
share such data for marketing and promotional purposes such as, but not limited to, calls, emails, and/or SMS. I/We may withdraw such consent at anytime by calling the PNB Credit Cards Customer Service or sending a
notification via mail or email to PNB.
I/We hereby agree to waive my/our right/s regarding the confidentiality of deposits under R.A. 1405, as amended, as the disclosure is necessary and relevant in the evaluation of my/our application for a PNB Credit Card
and to ensure a successful debit under an auto-debit payment agreement with my/our PNB account should I/we decide to avail of the auto-debit payment facility to my/our PNB Credit Card. I/We hereby authorize PNB,
in the event that my account becomes past due, to offset against my PNB deposit/s any upaid balances or to endorse my account to an accredited third party agency, and subsequently cancel my card. I/We further
authorize and consent to the Philippine National Bank to be the recipient of these information and to conduct random verification with the BIR in order to establish authenticity of the Income Tax Retur (ITR).
I/We hold ourselves, jointly and severally liable for all obligations and liabilities arising from the use of the PNB Credit Card and supplementary card/s and, in the event that my/our application for a PNB Credit Card is
disapproved, the Philippine National Bank is under no obligation to provide me/us with the reason for such a decision.
The accomplished application form and requirement/s submitted will become the property of the Philippine National Bank. The Philippine National Bank is under no obligation to return the said documents.
Further hereby declare, that in compliance with BSP Circular #472, I agree to send copy of my latest duly-stamped ITR or BIR Form 2316; or latest 3 months payslips, if employed; or Audited Financial Statements, if self-employed.

Source Code

FOR BANK USE ONLY

Program Name/Code:

Branch / Channel Code:

Employee No.:
Signature of Principal Applicant

PNB Credit Cards -- Miles and Miles Ahead

Date

Solicitors Name: ________________________________

CRR Code:

OPAF_April 2016