AUTHORIZATION FORM FOR THIRD PARTY INQUIRIES

CLG – UNSECURED COLLECTIONS – CREDIT CARDS

Date: ________________

TO: BANCO DE ORO – CONSUMER LENDING GROUP – COLLECTIONS DEPT.

I, ______________________________________, hereby authorize ____________________________, whose

signature and information appear below, to report concerns on my behalf and inquire on the selected information as
detailed below concerning my BDO Credit Card/s:
Card 1 (Credit Card Number) _________________________________________
Card 2 (Credit Card Number) _________________________________________

Card 3 (Credit Card Number) _________________________________________

Card 4 (Credit Card Number) _________________________________________

Authorized Person's Details/Information:

Full Name _________________________________________________

Relationship to the Cardholder _________________________________________________
Date of Birth _________________________________________________
Last School Attended _________________________________________________
Mother's Full Maiden Name _________________________________________________
Mobile Number _________________________________________________
Employer Name _________________________________________________
Employer Address _________________________________________________

Specimen Signature _________________________________________________

Authorized Person will be allowed to inquire about the following information

- Outstanding Balance - Status of Various Requests

- Statement Balance and Due date - Annual / Finance / Late charges reversal
- Available Credit Limit - Last Payment Made
- Available Cash Advance - Installments
- Billing Address inquiry - Disputes
- Account Status

In this connection, I hereby irrevocably agree to indemnify and render Banco de Oro, its directors, officers, employees
and assigns free and harmless from any and all liabilities, actions, claims, suits and damages (including attorney’s
fees and costs of suit) which may arise as a result of or in connection with the implementation by Banco de Oro of the
authority herein granted. This indemnification clause shall survive the termination of this authorization.

I agree that Banco de Oro shall have the right to refuse implementation/performance of the authority herein given
upon reasonable ground/s as determined by Banco de Oro.

____________________________________
Cardholder's signature over printed name
NOTE: KINDLY ATTACH A COPY OF 1 VALID ID OF THE CARDHOLDER AND AUTHORIZED REPRESENTATIVE TOGETHER WITH THIS
FORM). PLEASE FAX OR EMAIL DOCUMENTS THRU _________________________________.

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FOR BANK USE ONLY:
RECEIVED BY: REVIEWED BY: APPROVED BY:

PRINT NAME & SIGNATURE / DATE PRINT NAME & SIGNATURE / DATE PRINT NAME & SIGNATURE / DATE