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POST PAY INSTALLMENT

REQUEST FORM
IMPORTANTNOTE: Please accomplish this form and submit via email to AUB Credit Cards at creditcards@aub.com.ph or fax (+632) 325-0741. For
further inquiries, please contact the AUB Customer Service Hotline at (+632) 282-8888 or Domestic Toll Free 1-800-10-282-8888 (for PLDT use only)

CARDHOLDER INFORMATION

Cardholder Name:
LAST NAME FIRST NAME MIDDLE NAME
AUB Card Number Expiry Date
______________
(16 Digits): (Valid Thru):
Email Address : Mobile Number:

POSTPAY INSTALLMENT TRANSACTION DETAILS

Please use another sheet/form if space provided is insufficient


Transaction Amount/
Transaction Date Posting Date Merchant Name
Currency if Applicable

STANDARD RATES
POST PAY INSTALLMENT PLAN

Please choose your preferred monthly installment payment term:


Term Monthly Add-On Rate Factor Rate Annual Effective Interest Rate
 6 1.50% 0.181667 30.2306%
 12 1.30% 0.096333 27.6469%

TERMS AND CONDITIONS


 I acknowledge that I have read, understood and agree to the Terms and Conditions of the Balance Transfer
Installment Plan.
CARDHOLDER ACKNOWLEDGMENT

UNDERTAKING AND CERTIFICATION

By signing this form, I warrant that all information given in this application form is true and correct. I hereby authorize AUB to verify such
information and investigate from whatever sources it may consider appropriate. In case of material change in any of the foregoing
information, I hereby undertake to immediately notify AUB of the same. I understand that misrepresentation under this application form
and any document submitted therewith constitutes sufficient grounds for legal action against me, as well as for the denial of this
application and/or the cancellation of my credit card/s, without need of prior notice.

I hereby acknowledge and authorize the transfer, disclosure and communication of any information relating to my credit card/s with AUB
and/or its parent companies, subsidiaries or affiliates, as well as its third party providers, agents, and representatives, for purposes of data
processing and storage, customer satisfaction surveys, products and service offers and updates through post/email/fax/SMS/telephone,
and for any other purpose AUB deems appropriate and relevant to me, and/or as may otherwise be required by laws, rules and
regulations. I also hereby authorize AUB and any of its authorized representatives to conduct random verification with the Bureau of
Internal Revenue to establish the authenticity of the income tax returns and financial statements that I have submitted to AUB, as well as
my credit information to the credit bureau and/or as may be necessary for AUB to comply with RA. 9510 and its implementing rules and
regulations. The foregoing constitutes my written continuing consent to any such submission and disclosure of information relating to my
accounts for the purposes stated above and as may otherwise be required under applicable laws, rules and regulations. Accordingly, I
hereby hold AUB free and harmless from any liability that may arise from or otherwise be related to any such transfer, disclosure,
processing and/or storage of information relating to my accounts.

SIGNATURE OVER PRINTED NAME DATE


FOR AUB CARDS USE ONLY

Processed by: Date


Remarks:

AUB is regulated by the Bangko Sentral ng Pilipinas.


For inquiries or complaints, you may contact AUB Credit Cards through Customer Service Hotline 282-8888 or BSP Financial Consumer Protection
Department at Tel. # 708-7087 or email at consumeraffairs@bsp.gov.ph

AUB POST PAY INSTALLMENT REQUEST FORM VER2019.01.02