CLASS D

LAND BANK OF THE PHLIPPINES Exhibit 2

Branch ______________________

LANDBANK CASH CARD/PREPAID CARD ENROLLMENT FORM

Date: ___________________________

Please check the type of card being enrolled:

Cash Card Prepaid Card Individual Institution
Individual Regular (Master Card/Others, pls specify_________)
Institution Gift Card Master Card/Others, pls specify_________

Purchaser's Information
Purchaser's Name: With existing account with LBP Yes
cNo c
If yes, pls specify Acct. No/s.: _____________________
Cash Card Number/s:
ADDITIONAL INFORMATION FOR WALK-IN INDIVIDUAL PURCHASER, AND CARDHOLDER OF INSTITUTIONAL PURCHASER:
Cardholder's Name Gender:
Ms.
c Mr. Marital Status:
c Mrs.
c ______
c
Permanent Address: Zip Code:

Present Address: Zip Code: Recent Photo

(optional)
Place of Birth: Date of Birth: Nationality: Mother's Maiden Name:

Type of ID Presented: ID Number Presented/Place of Issuance Profession TIN Source of Fund:

Name of Employer/Company/Business/School: Contact Number/s: (home/office/mobile) email Address Gross Salary

Cardholder's Information
Cardholder's Name: Contact Number/s: Date of Birth:

Permanent Address: Zip Code: Relationship with

the Purchaser:

Present Address: Zip Code:

Name to Appear on the Card (with maximum of 22 characters)

Initial Load Amount of Fees/Charges to be paid:

$ ___________________ P ___________________ ₱ ___________________

(for Prepaid Travel Card) (for Cash Card/Regular Prepaid) (Initial Cost of the Card)

I/We hereby certify that the above information is true and correct:

____________________________ ____________________________
Signature Over Printed Name Signature Over Printed Name
of Purchaser/Applicant/Authorized Signatory of Purchaser/Applicant/Authorized Signatory

FOR BANK'S USE ONLY

Processed by: Checked by: Approved by:

Customer Associate/NAC BOO/BSO1 Branch Head

Date/Time: ___________________________ Date: ___________________________ Date: ___________________________

1
for Branches without BOO
Validation Print (if paid thru cash):

CASH CARD/PREPAID CARD/PIN MAILER CLAIM STUB

Card Number: Card Holder's Name: Purchaser's Name: Date:

Prepaid Card Released by: PIN Mailer Released by: Approved for Release: Card/PIN Mailer Received by:

Card Custodian PIN Mailer Custodian Branch Head/BOO/BSO Signature Over Printed Name
of Purchaser/Cardholder
Date/Time: ___________________________Date/Time: ___________________________
Reminders:
- You may claim your Prepaid Card after 7 banking days for Metro Manila Branches, and 15 banking days for Provincial Branches, and a replacement fee shall be collected
- Unclaimed Prepaid Card/PIN Mailer shall be perforated after 120 calendar days (for CCT)/30 calendar days (regular) from issuance/re-issuance
- Please sign your Prepaid Card immediately
Validation Print (if debited from deposit account):

LANDBANK Cash Card/Prepaid Card Enrollment Form Page 1 of 1