My Personal Reverence Name (Last, First, Middle)

COMPLETELY fill out this application form.

Please indicate "N/A" if not applicable. About Me
IMPORTANT: Please provide complete information so
your application can be immediately processed.
Home/ Employment Address
Name

About My Work Employment Type

Employed self-employed Employer/Business Name
retired
Employer/Business Name
Employer/Business Phone Number
Last
Middle
First

of others Years with Present Employer/Business

Name to appear on card (Must not exceed 23 characters, including spaces)
Position
Nature of Business/Industry
The information contained in this application form is accurate as of printing
date (08/13) and is subject to change after such date. For inquiries on any
change in the information contained in this application since printing date,
please call our 24-hour BPI Express Phone at 89-100 (Metro Manila) or toll-free
1-800-188-89100 (Outside Metro Manila).
Mother's Full Maiden Name
Office/Business Address
Birthdate (mm/dd/yy)
Place of Birth
Gender
Male
Zip Code
IMPORTANT INFORMATION 1. Applicants must be at least 21 years old
with a minimum fixed monthly income (excluding overtime,
commissions or service fees) of P15,000. 2. Applicants must have a business or
residence contact number and an active email address. 3. Applicants must
completely fill out and sign this application form.
Female
Office/Business Phone Number
Local/Ext. Number
Fax Number
Civil Status

Single
Married
separated
Gross Annual Income

No. of Dependents Widowed SSS Number/GSIS Number

Email Address
TIN. (Tax Identification Number)
Previous Employer
Years with Previous Employer/Business
Car Ownership No. of cars owned
Owned
Mortgaged P.
---/ month
w
w
wwwwwwwwwwwwwwwwwwwwwwwwwww
wwwwwwwwww

Citizenship
About My Finances/Bank Relationship MY OTHER
CREDIT CARDS (IF ANY) CREDIT CARD
CARD NUMBER CREDIT LIMIT
DOCUMENTS REQUIRED: Only application forms with complete documents
will be processed. Please submit a photocopy of the following: A. Proof of
Identification (front and back of at least one (1) valid ID with
 picture):
• Passport
• Postal ID
• BIR/TIN ID
• Voter's ID
• SSS/GSIS ID
• Driver's License Company ID issued by private entities/institutions. Philippine
Regulatory Commission (PRC) ID registered with the SEC or regulated by the
SEC or IC A Non-Filipino Resident, must submit his Alien Certificate of
Registration (ACR), work permit or
Embassy Accreditation Papers. B. Proof of Income: FOR EMPLOYED
FOR SELF-EMPLOYED Submit a photocopy of ANY of the following:
Submit a photocopy of the following:
• Certificate of Employment or Contract of
• Latest Audited Financial Statements (AFS) with Employment (for Overseas Filipino Workers)
BIR or bank stamp AND latest Income Tax Return
• Latest payslips
(ITR) with BIR or bank stamp
• Latest Income Tax Return (ITR) with BIR or bank stamp
Note: Applicants who have credit cards for which they have been a principal
cardholder for at least one year are no longer required to submit income
documents if they are able to provide a photocopy of their credit card or latest credit
card statement/s.
Filipino
Non-Filipino (please specify:) -
EXPIRY DATE
Preferred Billing Address (where correspondences will be sent:)
Office
Home
LLLLLLLLL

Home Address
www

MY BPI/BPI FAMILY SAVINGS BANK ACCOUNTS (IF ANY)

BPL ACCOUNT/LOAN NUMBER DEPOSIT/LOAN TYPE
BRANCH LOCATION
Zip Code Permanent Address (Please fill out if not the same as Home Address.)
Home Ownership
Owned
Rented P
/month
MY OTHER CREDITORS (IF ANY)
CREDITOR DATE GRANTED
Living w/ parents
Mortgaged P
/ month
TERM AMOUNT GRANTED MONTHLY AMORTIZATION
Years of stay
Living w/ relatives
Home Phone Number
Fax Number
DECLARATION (PLEASE READ BEFORE SIGNING) | certify that the
information given by me is true and correct and that any material
misrepresentation or falsity therein shall be construed as an act to defraud BPI
Family Savings Bank for which civil and/or criminal liability can be pursued
against me. I hereby authorize BPI Family Savings Bank to: () inquire about and
investigate all the declared information from whatever sources BPI Family
Savings Bank may consider appropriate; (ii) use any contact details to
communicate to me for whatever purpose; (iii) disclose any information herein
provided to any person or entity. For this purpose, I agree to indemnify and hold
BPI Family Savings Bank free and harmless from any and all claims, liabilities,
damages, suits or causes of action of whatever nature, now or hereafter arising
from or in connection with the foregoing authorization. Further, I agree that:
(i) the application form and the related documents submitted to BPI Family
Savings Bank shall not be returned to me for whatever reason; (ii) in case of
disapproval of my application, BPI Family Savings Bank is under no obligation to
provide me with the reason for such decision; and (iii) BPI Family Savings Bank
reserves the right to restrict the use of or to terminate/cancel the card without
need of prior notice from BPI Family Savings Bank if it is later determined that
the information certified by me is false. In the event that my application is
approved, my use of the credit card shall be deemed my acceptance/agreement
with the terms and conditions governing the issuance and the use of the
BPI Family Credit Card as printed at the back of the card carrier which I will
receive together with my credit card. I acknowledge that the said terms and
conditions may likewise be viewed in the BPI Express Online website. I
accept liability for all charges to the principal card and supplementary cards.
Any alteration, amendment, exception, reservation or scribbling made by me
herein, in the terms and conditions governing the issuance and use of the
BPI Family Credit Card, as well as in the provisions contained in the Statement of
Account (SOA), SOA, Installment Plan Contract, Charge Slip, other card
documents, Suretyship Agreement and/or such other related instruments or
documents, not duly approved in accordance with appropriate procedures of
the BPI Family Savings Bank, shall not be valid and binding.
My Supplementary Cardholders - 1st Supplementary Card
FREE FOR LIFE! Note: All Supplementary must submit a photocopy of
one (1) valid ID with picture.
Name Last
First
Middle
Mobile Number
BPI Electronic Alert will allow you to receive product and 09 UUUUUL
promo updates via SMS, email or both. How would you like
to be updated? Email Address
via Email Signature:
via SMS Kindly indicate if you're related to a BFB Director, Officer,
Stockholder, and Related Interest (DOSRI): Name Relationship:
Parent Parent-in-law
Spouse
Children About My Spouse Name (Last, First, Middle) Last
First
Middle
Please provide an active email address to receive FREE Statement of Account Alerts
Name to appear on card (Must not exceed 23 characters, including spaces)
RRRR

Birthdate (mm/dd/yy)
Mobile No.
Gender Male Female Relationship to Principal Cardholder
WAR

Home No.
Office No.
Email Address
Employer/Business Name
PRINCIPAL CARDHOLDER
2 Name
Date
First
Last
Middle
Years with Present Employer/Business
Position
1st SUPPLEMENTARY CARDHOLDER
Date
Name to appear on card (Must not exceed 23 characters, including spaces)
Office/Business Address
mmm

Zip Code. Gross Annual Income

2nd SUPPLEMENTARY CARDHOLDER
Date
Birthdate (mm/dd/yy)
Mobile No.
Office/Business Phone Number
Gender Male Female Relationship to Principal Cardholder
Home No.
Office No.
For BPI or BPI FAMILY SAVINGS BANK Use Only:
SELLER'S EMPLOYEE NO REFERENCE CODE BRANCH CODE / AGENT CODE
DOC. IMAGE NO.
Birthdate (mm/dd/yy)
TIN. (Tax Identification Number)
Email Address