7/17/2019 Union Bank - CIR

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 TMP-CH-90-20

EPAYCARD CUSTOMER ACCOUNT OPENING FORM

All fields with (CHECK) are MANDATORY.

ACCOUNT DETAILS
DATE (MM/DD/YYYY) BRANCH CUSTOMER ID NO.

CLIENT TYPE TYPE OF ACCOUNT ACCOUNT NO.

New Client Existing Client Peso Dollar

CARDHOLDER DETAILS
TITLE / SALUTATION NAME (Last Name, Given Name, Middle Name) GENDER
Male Female

CIVIL STATUS MOTHER'S MAIDEN NAME (Last name, Given Name, Middle Name)
Single Separated Widowed Married

BIRTHDATE (MM/DD/YYYY) PLACE OF BIRTH CITIZENSHIP/ NATIONALITY

Filipino Foreigner Dual Citizen
1

MOBILE NO.* * Your Company's HR Officer has automatically EMAIL ADDRESS:

enrolled you in receiving SMS Alerts. Kindly inform
them if you want to be removed from this service.

PRESENT ADDRESS (No. / Street / District / Barangay / City / Town / Province) ZIP CODE

PERMANENT ADDRESS Same as Present Address ZIP CODE

SSS NO./ GSIS NO./ TIN SOURCE OF FUNDS

Salary Business Commission/Fees Remittance Others

COMPANY NAME / BUSINESS NAME (if Self-employed)
DENTSU JAYME SYFU INC
BUSINESS ADDRESS (No. / Street / District / Barangay / City / Town / Province)
UNITED LIFE BLDG 837 ARNAIZ AVE MAKATI CITY
I am not a U.S. Person.
I am a U.S. Person.1
- U.S. Citizen OR
- U.S. Resident OR
- U.S. Green Card Holder OR
- U.S. Passport Holder
EMPLOYMENT DETAILS
POSITION/ DESIGNATION INDUSTRY
ADVERTISING
ZIP CODE CONTACT NO. EMAIL ADDRESS
1223 8705-788
FATCA INFORMATION
DOCUMENTARY REQUIREMENTS
I am not a U.S. Person but with U.S. indicators. (1) Certification, Consent, and Waiver AND Form W-9
(2) Certification, Consent, and Waiver AND Form W-9 OR
U.S. Place of Birth 3 Form W-8, Form W-8 BEN AND/OR Non-US passport OR
U.S. Resident Address / U.S. Mailing Address (including a U.S. post office box) 2 government ID evidencing citizenship in another country
U.S. Telephone Number 2 (3) Certification, Consent, and Waiver AND Form W-9 OR
Form W-8, Form W-8 BEN AND/OR Non-US passport OR
Standing instruction/s to transfer funds to an account maintained in the U.S. 2 government ID evidencing citizenship in another country OR
Power of Attorney or signatory authority granted to a person with a U.S. Address
2
Certificate of Loss of Nationality of the US or Form I-407, OR
“In-care-of” address or “hold mail” address that is the sole address the Foreign a reasonable explanation of account holder's renunciation
Financial Institution has identified for the account holder 2 of US citizenship OR the reason the account holder did not
obtain US citizenship at birth

CARDHOLDER'S SPECIMEN SIGNATURE

(Please provide three specimen signatures)
1) 2) 3)

CARDHOLDER ATTESTATION

By my signature herein, I acknowledge that my company’s authorized HR representative has discussed and I have read the UnionBank ePaycard Terms and
Conditions found in bit.ly/UBPePaycardTCs and the Bank's Privacy Policy found in bit.ly/UBPDataPrivacy and I confirm that I fully understand and agree to
abide by the terms stipulated and any future amendments thereto. For Checking Account/s, I agree and undertake not to use cheques, printed or secured from
printers, not accredited by your Bank and that I shall be held responsible and liable for any and all losses, damages arising from the violation of this undertaking.

I confirm that all information I provided are true and correct. I agree to inform Union Bank of the Philippines should there be any changes to my personal data
stated above. I consent to the disclosure of my personal data to UnionBank and other authorized third parties, including subsidiaries and affiliates, of UnionBank
to be used for the purpose of processing my application and for the assessment of my compliance with the necessary requirements needed for this application.
I understand that my personal information may also be used for review, audit, and reporting to Bangko Sentral ng Pilipinas and other regulators.

Ultimately, I hold the Bank free from any liabilities that may arise regarding my account, including those that may arise from the Bank’s imposition of restrictions
to or closure of my account that may be due to incomplete, inaccurate, and/or outdated information provided by me or my company’s HR.

JOY ANN DAJOYA

CARDHOLDER AUTHENTICATED BY AUTHORIZED HR REPRESENTATIVE
Signature over Printed Name / Date Signature over Printed Name / Date
FOR BANK'S USE ONLY (to be filled-out by the Sales Representative)
TYPE OF DEPOSIT CUSTOMER TYPE EMPLOYER ID RM/BM/AO CODE

REMARKS

IDENTIFIED & SIG. VERIFIED BY / DATE PROCESSED BY / DATE APPROVED BY / DATE APPROVED BY / DATE (FOR EDD)

Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Revised March 2020
 TMP-CH-114-15
EPAYCARD VISA DEBIT CARD AGREEMENT By using the EPAYCARD VISA Debit Card, the Cardholder unconditionally
agrees to be bound by the laws, rules, regulations, and official issuances applicable on the matter, now existing or
which may hereinafter be enacted, issued or enforced. All the Terms and Conditions in the EPAYCARD VISA Debit
Card Agreement have been read and understood by the Cardholder, as evidenced by the signature on the application form,
VISA Card and/or charge/sales slip.
These terms and conditions comprise the agreement between UnionBank of the Philippines and the Cardholder, in
connection with the Cardholder's EPAYCARD VISA Debit Card. This EPAYCARD Account Agreement is governed by the
provision of Bangko Sentral ng Pilipinas and applicable laws in the Philippines, relating to the covered transactions herein.
1.
Interpretation
1.1. In these terms and conditions
1.1.1. "Account" means the EPAYCARD account held or to be held with UnionBank, in the
name of a single Cardholder
1.1.2. "Account Currency" means the currency in which the Account is denominated.
1.1.3. "Bank" means UnionBank of the Philippines.
1.1.4. "Card" means a VISA Debit Card, including any renewal or replacement Card.
1.1.5. "Cardholder" means the person having power alone to operate the Account, in accordance with the Bank
mandate, in respect thereof.
1.1.6. "PIN" means the personal identification number issued to the Cardholder, from time
to time, for use of the Card.
1.1.7. "Password" means the password you use to access the Financial Services at the
unionbankph.com website and your EPAYCARD Account through a personal computer or other
electronic terminal.
1.1.8. "Transaction" means any cash withdrawal or payment made using the Card, or any
refund arising in connection with the use of the Card, in any authorized manner, for debit or credit to the
Account.
1.1.9. "Visa" means Visa International.
1.1.10. "Working Days" means Monday to Friday inclusive except Bank holidays.
1.2. In these terms and conditions, references to the singular include the plural and vice versa.
References to one gender include references to the other gender. The headings used herein
are for ease of reference only.
2. The EPAYCARD
Account
2.1. The Cardholder is responsible for all obligations arising out of the ownership and maintenance of an
EPAYCARD Account. This includes the amount of any check, draft or other instrument (each, an "Item")
deposited to the account and service charges to the account. The losses arising from the breach of any
representation or warranty made to the Bank or under applicable law, and the costs incurred to enforce the rights or
to collect any sum the Cardholder owes the Bank, including, to the extent permitted by law, reasonable attorney's
fees.
2.2. Deposits to Account
2.2.1. The Cardholder authorizes the Bank to accept cash and Items for deposit to the Deposit Account, if they are
made payable to the Cardholder. The Bank is also given the authority to deposit wire transfers and other
forms of credit (such as direct deposits or other automated clearinghouse entries). Second endorsed
checks, post dated and stale checks are not accepted for deposit.
2.2.2. In receiving deposits, except cash, the Bank acts only as a collecting agent and
assumes no responsibility beyond the exercise of ordinary care. All deposits are posted to the EPAYCARD
Account in Philippine Pesos, subject to the rec eipt of final payment. If final payment is not received on any
Item deposited to the account or if any direct deposit, automated clearinghouse deposit or electronic fund
transfer to the account is charged back to the Bank for any reason, the Cardholder agrees to pay the
amount of the chargeback. The Bank is authorized to debit the EPAYCARD Account, without prior notice
and at any time, for the amount of the returned Item or other deposit, the returned item fee, any interest
paid on the deposit, and any othe r fee paid or loss incurred. The Bank may also use any other legal
remedy to recover the amount owed.
2.2.3. The Bank is not responsible for any transactions until these have been received and recorded. The Bank is
not liable for the default or negligence of duly selected correspondents, or for losses in transit.
2.2.4. Funds from electronic payments, such as direct deposits of payroll or electronic benefits and cash deposits
the Cardholder makes to the EPAYCARD Account, will be available on the day the Bank receives the
payment.
2.3. The EPAYCARD Account earns interest at the rate and compounding frequency shown on the Schedule of Rates and
Fees, subject to applicable taxes.
2.4. The Cardholder will provide the Bank with the signature card and other documentation or information that is
requested, in connection with the EPAYCARD Account. The Cardholder is required to update the signature every
five (5) years or whenever deemed necessary by the Bank.
2.5. The account will become inactive after a year of inactivity and becomes dormant after 2
years of inactivity. After ten (10) years of continuous inactivity, the dormant account will be escheated in favor of
the Philippine Government, in accordance with the Unclaimed Balances Law. The Bank will have no further
liability to the Cardholder f or such funds.
2.6. Deposit Insurance
2.6.1. Deposits are insured by the Philippine Deposit Insurance Corporation (PDIC), up to a
maximum deposit insurance coverage (MDIC) per depositor’s account. As of June 1,
2009, the maximum coverage amount is Five Hundred Thousand Pesos (P500,
000.00) per depositor's account.
2.6.2. PDIC shall presume that the name appearing on the deposit instrument is the actual/beneficial owner of the
deposit, except as provided herein.
2.6.3. In case of transfers or break-up of deposits, PDIC shall recognize actual/beneficial ownership of
transferees who are qualified relatives of the transferor. Qualified relatives are transferees within the third
degree of consanguinity or aff inity of the
tran
sfer
or.
2.6.4. In case of (a) deposits in the name of, or transfers or break-up of deposits in favor of, entities, either singly or
jointly with individuals, and (b) transfers or break-up of deposits in favor of non-qualified relatives,
whenever such transfers/ break up will result in increased deposit insurance coverage, PDIC shall
recognize beneficial ownership of the entity or transferee, provided that the deposit account records show
the following: a. Details or information establishing the right and capacity or the relationship of the entity
with the individual, or b. Details or information establishing the validity or effectivity of the deposit transfer,
or c. Copy of Board Resolution, order of competent government body/ agency, contract or similar
document as required/ provided by applicable laws.
2.6.5. In the absence of any of the foregoing, PDIC shall deem the outstanding deposit as maintained for the
benefit of the transferor, although in the name of the transferee, subject to consolidation with the other
deposits of the transferor.
2.6.6. PDIC may require additional documents from the depositor to ascertain the details of the deposit transfer or
the right and capacity of the transferee or his relationship to the transferor.
3. Financial
Services
The Bank offers the following types of Financial Services for an Epaycard Account through available channels:
3.1 Internet Banking via unionbankph.com website and Mobile Banking via uMobile mobile application.
3.1.1 View the Current Balance, Available Balance and Transaction History
3.1.2 Transfer the funds from the EPAYCARD Account to the Cardholder’s other enrolled accounts or to third
party accounts within the Bank. The Bank will effect the online fund transfer provided there are sufficient
funds available in the EPAYCARD Account. The Cardholder will be responsible for informing the third
party account holders of the transfer made. The transfers are irrevocable once effected.
3.1.3. Pay the bills from the EPAYCARD Account to institutions with which the Bank has collection agreements.
3.1.4. Terms Relating to Goods and Services Purchased using Electronic Transfers.
3.1.4.1. No Liability. The Bank will not be responsible, in any way, for any goods
or services the Cardholder decides to purchase, including and without limitation, their
quality, safety, legality or delivery. The Bank will not become involved in any dispute
involving such goods or services. The Cardholder also agrees to hold free and harmless and
release the Bank and its respective directors, officers, employees and agents from any and
all claims, demands and damages between persons using the Financial Services of
unionbankph.com, including any claims, demands or damages arising out of or
related to the purchase or sale of goods or services.
3.1.4.2. Charges and Taxes. The Cardholder is responsible for paying any and all
charges and/or taxes which may be imposed by the Bank and the proper authorities,
respectively, arising from the availment of the services and products under the EPAYCARD
Account.
3.2 SMS Alert
3.2.1 The Cardholder agrees that UnionBank may send or communicate with you through text messages (SMS)
through your SMS-enabled cellular phone for specific prompts, reminders and notices from time to time
concerning available Account information
and other matters relating to your Accounts with UnionBank.
3.2.2 The Cardholder acknowledges and accepts that each SMS may be sent without being encrypted and
may include some information pertaining to your Account(s). It is the Cardholder’s responsibility to ensure
the security of such cellular phone and to hereby hold UnionBank free and harmless against any and all
liability, administrative, civil or criminal, including, but not limited to those relating to secrecy laws or
regulations (if any), should any SMS Alerts be viewed or accessed by persons other than you.
3.2.3 The Cardholder hereby agrees that UnionBank does not guarantee the delivery or accuracy of any SMS Alert
which are purely for convenience, information and notification purposes only. The Cardholder shall be
UnionBank ePaycard
Terms & Conditions
fully responsible to monitor the due performance and compliance of needed obligations.
4. The Card
4.1. The Cardholder will be given an ATM card that is linked with the EPAYCARD account. The Card belongs to the Bank
and any authorized officer, employee, associate or agent of the Bank may retain the Card, require the Cardholder to
return the Card or suspend the use of the Card at any time in its absolute discretion. The Bank shall not be liable for
any loss or damages suffered by the Cardholder as a result thereof.
4.2. The Card will not become valid or operational until the Cardholder acknowledges receipt of the Card by signing on
the appropriate Bank documents. The Card is only valid for the period shown on it and must not be used
outside that period or if the Bank has required, by notice in writing to the Cardholder, that it be returned to the
Bank. W hen the period of validity of a Card expires, it must be destroyed immediately by the cardholder by cutting it
in half through the magnetic strip.
4.3. The Cardholder must take all reasonable precautions to prevent unauthorized use of the Card, including, not allowing
anyone else to use the Card and telephoning the Bank, in accordance with paragraph 4.2 above, to immediately
acknowledge receipt of the Card.
4.4. If the Card is lost or stolen, the Cardholder, or any other person acting on behalf of the Cardholder, shall
immediately notify the Bank or the Visa Customer Assistance Service by telephoning the card number(s) and
information of the Cardholder and the Cardholder must , in addition, immediately notify relevant law enforcement
agencies. The Cardholder must confirm the loss of the Card by notice in writing to the Bank, within seven days
of having notified the Bank by telephone.
4.5. The Cardholder must cooperate with any officers, servants, employees, as sociates or agents of
the Bank and/or law enforcement agencies in any efforts to recover the Card, if it is lost or stolen. The Bank
may disclose information about the Cardholder and the Account if the Bank thinks it will help avoid or recover any loss
to the Cardholder or the Bank resulting from the loss, theft, misuse or unauthorized use of the Card.
4.6. If the Card is found after the Bank has been given notice of its loss or theft, the Cardholder must not use it again. The
Card must be cut in half, through the magnetic strip.
5. The PIN
Aln ATM PIN will be issued to the Cardholder. All reasonable precautions must be taken to avoid unauthorized use, including
destroying the PIN mailer issued by the Bank promptly after receipt, never disclosing the PIN to someone else, never writing the
PIN on the Card or any other item normally kept with the Card, never writing the PIN in a way that can be understood by
som eone else and immediately notifying the Bank if someone else knows or is suspected of knowing the PIN. The Bank
recommends that you regularly change your PIN.
6. Card Facilities
6.1. The Cardholder may use the Card, in conjunction with the PIN, to withdraw money from automated teller
machines that accept the Card when they are operating. The amount of money to be withdrawn by the Cardholder
shall be debited to the Account. ATM withdrawals are available up to the daily authorization limits specific to
members of the Bank's service network(s), provided that the available balance is greater than the amount
requested.
6.2. The Card may be used to purchase goods and services from merchants that participate in the service network and
have agreed to accept the Card as a means of payment by signing a sales voucher, by entering the Card information
on the Internet, by signing a mail order purchase from showing the number printed on the Card or by placing an order
by telephone and quoting the number printed on the Card. Purchases made with the card are referred to as
point-of-sales (POS) transactions, and will be charged against the EPAYCARD Account.
6.3. The Bank may also refuse to allow any withdrawals, without liability to the Cardholder, if there is a concern that one or
more transactions on the account may have been unauthorized or fraudulent. If there is a dispute concerning the
EPAYCARD Account that makes the Bank uncertain regarding the instructions that have been given, the EPAYCARD
Account is garnished or attached, the EPAYCARD Account has been pledged as collateral for a debt, the availability
of the funds on deposit cannot be verif ied, any required documentation has not been presented, or the Cardholder has
failed to repay an obligation to the Bank on time.
6.4. In addition to the amount of all Transactions, certain charges will be debited to the Account as provided for herein.
7. Charges
7.1. The Bank shall charge a fee to the Cardholder with respect to each cash withdrawal made using the Card for which a
charge is levied by Visa, Megalink, and Bancnet, in accordance with the Bank's schedule of fees from time to time in
force.
7.2. The Cardholder agrees to pay the charges, as shown on the Schedule of Rates and Fees. As these charges are
incurred or, at the Bank's option, the charges shall be deducted directly from your EPAYCARD Account balance. The
Bank shall not be liable for the dishonour of Items or other debits resulting from the deduction of any charges, as
authorized by the acceptance of these terms.
7.3. The Bank shall convert the amount of every Transaction made in a different currency to the
Account Currency. The Bank shall make the conversion based on the VISA Foreign Exchange rate at the time of the
transaction. If the Account Currency is in Philippine Pesos and the Cardholder uses his Card outside the Philippines,
the transaction shall be converted to its Philippine Peso equivalent, based on the VISA Foreign Exchange rate at the
time of the transaction. Similarly, if the Account Currency is US Dollars and the Cardholder uses his/her Card at a
Philippine peso-denominated, VISA affiliated merchant, the transaction amount will be converted to its US dollar
equivalent, based on the prevailing VISA Foreign Exchange rate, at the time of the transaction.
7.4. The Cardholder shall be charged in respect of every withdrawal Transaction made in a currency other than the Account
Currency with respect to the conversion of the amount of the transaction into the Account Currency, in accordance
with the Bank's schedule of fees from time to time in force. The following transaction fees shall be imposed on all ATM
transactions of the Cardholder outside the Philippines:
7.4.1. US $3.00 for every ATM transaction approved;
7.4.2. US $1.00 for every ATM balance inquiry;
7.4.3. US $1.00 for every ATM transaction declined for reasons such as insufficient funds and/or exceeds the
daily transaction frequency
7.5. The following Annual Membership fee scheme shall apply to the Card:
7.5.1. An annual membership fee in the amount of Php 350.00 shall be imposed by the Bank.
7.5.2. The Bank will debit to the Account, the amount of annual membership, at the end of the
account opening anniversary month.
8. General
8.1. The total amount of any Transactions carried out in any one day shall be limited to such amounts and by such
other conditions, as shall be notified by electronic means or in writing to the Cardholder, by the Bank, from time to
time, with effect from the date of such notice.
8.2. The Bank will issue a Card only if the Cardholder has completed an application form and it has
been accepted by the Bank, or if the Bank, at its discretion, is replacing or ren ewing a Card.
8.3. The Cardholder is not authorized to enter into Transactions us ing the Card to a value in excess of the credit balance (if
any) of the Account.
8.4. If the Bank is asked to authorize a Transaction, the Bank may take into consideration any other
Transactions which have been authorized but which have not been debited to the Account (and any other
transactional activities upon the Account). If the Bank determines that there are or will be insufficient available funds in
the Account to pay the amount that would be due in respect of such Transaction, the Bank may, in its own abs olute
discretion, refuse to authorize such Transaction, in which event, such Transaction will not be debited to the Account.
The Bank shall not be liable for any loss or courses of action resulting from any such refusal to authorize any
Transaction.
8.5. The card shall not be used as payment for an illegal purchase.
9. Termination
9.1. The Cardholder agrees to notify the Bank of any intention to close the EPAYCARD Account.
The Bank reserves the right to request that the notice be in writing that affirmatively acknowledges that closing the
account could affect the receipt of Financial Services.
9.2. The Bank may also initiate account closing if any of the following scenarios happ en:
9.2.1. EPAYCARD kits unclaimed beyond the prescribed period
9.2.2. Automatic closure for accounts with insufficient balance to pay corresponding bank
charges
9.2.3. Fraudulent
transactions
9.2.4. Failure of client to pay the full annual fee three (3) months after the account anniversary
date
9.3. After an EPAYCARD Account is closed, the Bank has no obligation to accept deposits or pay any outstanding Items
or other debits. The Cardholder agrees to hold the Bank harmless for refusing to honor any Item, credits or other
debit on a closed account.
9.4. The Agreement comprised in these terms and conditions shall be deemed to remain in full force and effect if and in so
far as any Transaction is completed but not debited to the Account pri or to termination thereof.
9.5. The EPAYCARD Account will be reclassified as a personal account and be subject to service charges upon either of the
following conditions:
9.5.1. Cardholder’s resignation from his company
9.5.2. Two years of account inactivity, which deems the account dormant
9.6. Termination of the Agreement comprised in these terms and conditions shall not prejudice any liability in respect of
things done or omitted to be done prior to termination thereof.
10. Miscellaneous
10.1. The Bank shall not be liable to the Cardholder for any loss suffered as a result of the Bank being prevented from or
delayed in providing any banking or other services to the Cardholder due to strikes, industrial action, failure of power
supplies, systems or equipment or causes beyond the Bank's control.
10.2. These terms and conditions and the banking practices and charges relating thereto may be changed by the Bank at any
time by notice thereof to the Cardholder. Any such changes will be effective from the date of the notice or such later
date as may be specified therein.
10.3. The Bank may, from time to time, introduce new, or change the services offered in our
unionbankph.com
W ebsite
10.4. Cards unclaimed after ninety (90) calendar days shall be destroyed.
CARDHOLDER
Signature over Printed Name / Date