Credit Card

Application Form
Write in PRINT and in blue/black ink only.

Card Information Other Credit Cards Highlighted fields are mandatory.

Card of choice:
Bank: ______________________________ Credit limit: ___________________________________

HARRIS C. VILLAREAL
Card no:____________________________________________ Expiry: _________________
Next Mastercard Gold Mastercard Platinum Mastercard
Your approved card type may vary based on our qualification requirements and credit assessment.
Secured card? Yes No
Billing type Single currency (Peso billing) Dual currency (Peso & USD billing)
Dual Currency is available for Platinum Mastercard. You will be issued with a single currency card if no option is chosen.
Bank: ______________________________ Credit limit: ___________________________________
Delivery address Your credit card Statement of Account (SOA)
Present home address Office address will be sent to your email address on record Card no:____________________________________________ Expiry: _________________
through our Electronic Statement of Account
Note: Your card/credit card statements may be sent to any of the
(eSOA) facility. Thanks for going paperless! Secured card?
addresses in your application form if you do not indicate which Yes No
your preferred delivery address is. I still prefer that a printed SOA be sent to my delivery address.

May be any relative, friend and/or trade reference not living with you;
Personal Information Personal References officemates not allowed

I am a Security Bank depositor
My payroll is with Security Bank
Name to appear on card
(First, Middle, Last)
Security Bank Account No. Complete name (First, Middle, Last) Relationship
or Payroll Account No.: _______________________
Branch: ____________________________________
Contact numbers
(Max 21 characters, nicknames not allowed)
Home _____________________ Office _____________________ Mobile _____________________

Spouse’s Information

Complete name (First, Middle, Last) Complete name (First, Middle, Last) Date of birth (mm/dd/yyyy)

Date of birth (mm/dd/yyyy) Mother’s full maiden name (First, Middle, Last)
Company/Business

Citizenship Place of birth Sex

Male Female Contact numbers
Civil status No. of dependents
Single Married Separated Widowed
Area code Landline number Mobile number
Education
College/Graduate Postgraduate Technical/Vocational
Affirmation & Authorization
High School

Home ownership
Owned
Home landline number
Area code
Email address
Taxpayer Identification Number (TIN)
Submitted ID type (Passport, Driver’s License, etc) ID number
Present home address
No./Block/Street
City
Permanent home address
No./Block/Street
City
Financial Information
Employment status
Employed
Employment type (If employed)
Regular/permanent
Nature of work/business
Company name
Position/Occupation
Office email address
By signing below, I confirm that the information I provided is true and correct. I
Living with
Mortgage Rented
relatives
Other ___________ authorize Security Bank to seek confirmation from external sources it deems
appropriate to verify the information I provided. I also acknowledge that
Mobile number
information on my deposit accounts, placements or credit dealings and any
other information may be requested as part of the credit card approval process.
Landline number
I also acknowledge that falsifying information on the enclosed documents is
sufficient ground for legal action and for the rejection of my application. I
SSS/GSIS/UMID number understand that should my application be declined, Security Bank
Corporation has no obligation to furnish the reason for such rejection. By
signing at the back of the card delivered to me, I signify my agreement to
Security Bank’s Terms and Conditions. Furthermore, I acknowledge that in
(Use of P.O. box as your residence address is not allowed) case of issuance of a supplementary card, I and my supplementary/ies and/or
surety/ies shall be jointly and severally liable for all information about the
Village/Brgy/Municipality supplementary cardholder/s as well as all purchases, and cash advances
made, including all interest and charges incurred through the use of the
Province ZIP code supplementary card/s and that in the event of delinquency, I hereby
authorize Security Bank Corporation to report and include my/our names in
(If different from present home address)
the negative listings of any credit card bureau or institution. I waive any
defense of minority, illiteracy or non-filiation on any supplementary
Village/Brgy/Municipality
cardholder/s. Such responsibility shall only cease upon my written request for
the supplementary card privileges to be terminated.
Province ZIP code
Further, I hereby give consent for Security Bank Corporation to share and
process any information relating to my account/s to any member of the
Highlighted fields are mandatory.
Security Bank Corporation Group of Companies and Bancassurance
Work tenure companies or their authorized Service Providers and representatives, for
Self-employed Retired Unemployed Yrs: _____ Mos: _____ purposes of cross-selling products and services, profiling and credit
evaluation/reference checks, audit and account balance confirmation and
allow them to contact us for this purpose (i.e. by e-mail, telephone, text, etc.),
Probationary Contractual/project hire
or in case of audit where our account is chosen as a sample for account
balance confirmation, which shall remain in effect for five (5) years after
account closure. I hold Security Bank Corporation free and harmless from any
and all liabilities, claims and demands of whatever kind or nature in
connection with or arising from this disclosure or reporting.
No, I do not agree to have my account/s used for product and services
information, and account balance confirmation.
Office landline number

Area code Landline number

Rank
Signature of primary applicant: _______________________________________
Owner Rank and file Junior officer Senior officer Others

AVP-SAVP VP-EVP President CEO to Chairman

Date: _____________________________________________________________
Gross annual income

Office/Business address For Bank Use Only

No./Block/Street Village/Brgy/Municipality

Source Branch/Agency Sales/Agent Promo/Event/Company Unique

City Province ZIP code code code code code offer code

BDGAPPFORM06.2020
 Eligibility
Eligibilitycriteria:
criteria: Documentary
Documentaryrequirements:
requirements:
1. 1.Must
Must bebe 21 21
to to
6565years oldold
years forfor
Primary Cardholders
Primary Cardholders 1. Accomplished
1. Accomplished andand signed
signed Security
Security Bank Bank credit
credit cardcard
application form
2.2.Must
Must bebe a regular
a regularpermanent
permanent employee
employeewith at least
with oneone
at least (1) year
(1) application
2. Proof of Income form
(under BSP Circular 622)
tenure or owns
year tenure oraowns
profitable businessbusiness
a profitable for the past three
for the (3) three
past years 2.
a. Proof
Employed of Income (under
applicants (ANYBSP ofCircular 622)
the following):
3. Must earn a minimum gross annual income of PHP 180,000 per
(3) years a. Employed applicants (ANY
• Copy of latest ITR stamped asof the following):
received by the BIR (2316)
3.year
Mustif you
earn have another credit
a minimum gross card or PHP
annual 360,000
income per year if
of PHP180,000 • Copy of latest
• Certificate ITR stamped
of Employment as received bysigned
& Compensation the BIR
by(2316)
the
you
perhave
yearno credit
if you card
have another credit card or PHP360,000 per
4. Must • Certificateauthorized
Company’s of Employment signatory & Compensation signed by the
yearhave
if youa home
have noand/or office
credit cardlandline number Company’s authorized signatory
5.4.Must have an email • Latest 3 months payslip with front/back copy of Company ID
Must reside withinaddress
a 25kmand mobile
radius of anumber
Security Bank branch
6.5.Must behave
in good credit standing • Latest 3 months
b. Self-employed payslip
applicants with
(ALL of front/back copy of Company ID
the following):
Must a home and/or office landline number
b. Self-Employed
• Copy of latest one applicants
(1) year ITR(ALL of theas
stamped following):
received by BIR (1701)
6. Must have an email address and mobile number
7. Must be in good credit standing • Copy
• Copy ofof latest
latest oneone
(1) (1) year
year ITR stamped
Audited as Statements
Financial received by BIR (1701)
• Copy
• Copy of of latest
Proof one (1) year(DTI
of Ownership Audited
or SEC Financial Statements
Certification)
Reminders: 3. Proof • Copy of Proof of Ownership
of Identification (ANY of the (DTI or SEC Certification)
following):
Reminders:
• Fill out legibly and sign this application form 3.
a. Proof
Driver’s ofLicense
Identification (ANY of the following):
• Only
• Fill applications
out legibly and with complete
sign information
this application and documents
form b.a. Driver’s License
Passport
will be applications
• Only processed with complete information and documents c. b. Passport
GSIS e-Card
• Application is still subject to credit checking
will be processed d.c.
SSSGSISID e-Card
(plastic card type with scanned signature and photo)
• Application is still subject to credit checking e. d.
TaxSSS ID (plastic card
Identification Number type(TIN)
withID scanned
(plastic signature
card type) and photo)
4. Fore. non-Filipino
Tax Identification citizen,Number
he/she must (TIN) have
ID (plastic card deposit
a hold-out type) or work
contract/visa with a term of at least 3 years.

Security Bank Mastercard Fees and Charges

Below is the table of fees and charges as of September 7, 2021. For the latest Security Bank Credit Card Fees and Charges, please visit www.securitybank.com/personal/credit-cards.

Complete Cashback Gold Next* Platinum World

Annual membership fee

PHP 3,000 PHP 2,500 No annual fee PHP 4,000 PHP 5,000
primary

Annual membership fee First supplementary card: waived for life.

PHP 1,500 PHP 1,500 No annual fee PHP 2,500
supplementary Succeeding supplementary cards: PHP 2,500

Interest 2% per month

Late payment fee PHP 1,000 (USD 20) or unpaid minimum amount due5, whichever is lower

Cash advance fee PHP 200 or USD 4 per transaction1

Over-the-counter
PHP 500 per transaction
cash advance fee
ChargeLight plan
5% of unbilled portion of the principal amount
pre-termination fee

Charge slip retrieval fee PHP 400 per sales slip

Lost card fee/

PHP 400 per card
card replacement fee
PHP 200 for full settlement of account Free for the first request
Card certification fee
PHP 300 for good credit standing PHP 150 for succeeding requests

Returned check fee PHP 1,250 for Peso per returned check or USD 25 for Dollar per returned check

Statement of account
retrieval fee
Foreign exchange transaction
PHP 50 per page if requested billing statement is more than 3 months old
All charges, advances, or amounts in currencies other than Philippine Peso (PHP) shall be converted to PHP. For dual currency, all charges,
advances, or amounts in currencies other than Philippine Peso (PHP) shall be billed in US Dollar (USD). All transactions will be converted
using Mastercard’s currency conversion rate at the time of posting. All converted transactions shall be charged with 1% Mastercard
assessment fee and 1.5% service fee, of the rates of which may be adjusted from time to time. The service fee shall likewise apply to
transactions involving foreign currencies converted to PHP at point of sale, whether executed in the Philippines, abroad, or online. Service
fees may also be charged to cover costs incurred to discharge the amount(s) due to Mastercard and/or acquiring bank and/or foreign
merchant affiliates.

Minimum amount due 3% of total amount due or PHP 500 (USD 10), whichever is higher

Overlimit fee 3
PHP 500 per occurrence

PHP 250 for Peso Account, if ADA account has insufficient funds.
ADA fee
USD 5 for Dollar Account, if ADA account has insufficient funds.

PHP 250 or amount equivalent to the credit balance whichever is lower will be charged to the accounts with credit balance that are
closed or with no activity for the past 12 months.
Account maintenance fee
USD 5 or amount equivalent to the credit balance whichever is lower will be charged to the accounts with credit balance that are closed
or with no activity for the past 12 months.

Multiple payment fee PHP 50 or USD 1 will be charged for every payment in excess of 2 payments within a billing cycle

Payment transfer fee PHP 100 if transferring from a Peso account and USD 2.5 if transferring from a Dollar account

PHP 500 will be charged for every refund request made to a cardholder’s overpayment amounting to PHP 1,000 and above.
Refund fee
PHP 200 will be charged for every refund request made to a cardholder’s overpayment for amount below PHP 1,000.

Quasi-cash fee2 2.5% of transacted amount

Change in credit card

PHP 2,000
statement cut-off fee4

Reinstatement fee 6
PHP 200

1
Cash Advance made overseas shall be subject to the fees of the servicing foreign franchise or bank.
2
Quasi-cash fee will be applied on gaming/gambling transactions and/or transactions made at gaming/gambling establishments, including the placement of wagers, purchase of lottery tickets, gaming
chips, as well as any other values in conjunction with any gaming or gambling activity.
3
Overlimit fee shall be charged for card usage beyond the approved credit limit. Visit bit.ly/SBC-CardsTCs for the full description.
4
Change in credit card statement cut-off fee shall be charged for every request to change your Security Bank Credit Card’s Statement Cut-off.
5
Unpaid minimum amount due refers to the total minimum amount due charged against the client for the latest billing cycle. Partial payment of the minimum amount due as appearing on the SOA will
not reduce the “minimum amount due” to be imposed against the client as late payment fee.
6
A reinstatement fee will be charged to past due accounts and cancelled cards that have been reinstated. Visit bit.ly/SBC-CardsTCs for the full description.
For bills not paid in full, the corresponding interest per card type will be applied to the Total Amount Due in your Statement of Account based on your average daily balance. A corresponding late payment
fee per card type will be charged to your card account if payment is not received on or before the Payment Due Date. Security Bank reserves the right to change said fees and charges from time to time
with prior notice.
*
Next Mastercard feature is auto-installment. Visit bit.ly/SBC-Next-TCs for the full description.
This product is not a deposit. This financial product of Security Bank Corporation is not insured by the Philippine Deposit Insurance Corporation (PDIC).
Security Bank Corporation is regulated by the Bangko Sentral ng Pilipinas with telephone number (+632) 8708-7087 loc. 2584, email address: consumeraffairs@bsp.gov.ph and website: www.bsp.gov.ph.
For inquiries and comments, please call our 24-hour Customer Service hotline at (+632) 8887-9188 or email us at customercontact@securitybank.com.ph.