Standard Chartered Bank - Application Form

Name MR MRS MISS

Name to appear on card (limit to 19 spaces; initials not accepted except for middle name)

Credit Card Application Form Print and fax this form to 830-1156 / 878-2026 __-__ __-__ __ __-__ __ __ __ __

Choose your Credit Card. If you choose more than one, please note that all cards will have a shared limit.
CLASSIC	GOLD
min. basic annual income: P120,000	min. basic annual income: P390,000
VISA Regular	VISA Regular	For Gold Card Applicants:
MasterCard Regular	MasterCard Regular	If we are unable to process your application
VISA Picture Card	VISA Picture Card	at this time, will you accept a Classic card?
MasterCard Picture Card	MasterCard Picture Card	Yes No
	Requested Credit Limit
Are you an existing customer? Yes No
If yes, pls. tick product availed Card No. EZ Loan Others
Applicants who have been previously declined may only re-apply after six (6) months

YOUR PERSONAL DETAILS

Birthdate				Place of Birth	Mother's Full Maiden Name

	mm	dd	yy		FIRST	M.I.	LAST

	Home Address
		No.	Street	Village/Baranggay/Municipality



City	Province	ZIP Code

	Permanent Address (If Different from Home Address)

No. of Years in Home Address:

	Home Phone:	Mobile Phone:	Best time to call me:	Email Address:

Civil Status

Single

Married

Widowed

Legally Separated

Education

High School

Some College

College

Post Graduate

Nationality	Filipino	Other
TIN No.
SSS / GSIS No.
ID / Passport No.

Home Ownership	Owned	Owned, Mortgaged	Company Provided
	Rented	Living with Parents or Relatives
Car Ownership No. of Cards owned:

CLUB NAME

	District ID	3770	3790	3810	3830	3860
		3780	3800	3820	3850	3870

PERSONAL REFERENCE

	Name (relative or friend)
	Employer/Business Name
	Complete Business Address
	Relation to Reference Relative Friend
	ZIP Code Bus. Tel. No.

SPOUSE'S PERSONAL DETAILS

	Name
	Employer/Business Name
	Complete Business Address

YOUR WORK & FINANCES

Employment	Private Sector	Retired	Unemployed	Others
	Government	Self-employed	Student
Years with Present Employer/Business: Total No. of Years of Work/Business Experience:

	If Self-employed, when was business established:
		mm	dd	yy

Position/Title	Nature of Business	Occupation

Others	008 Others	005 Others

Employer/Business Name

Business Address

Floor

Building

No.

Street

Village/Brgy./Municipality

City

ZIP Code

Business Tel No.

Mobile Number

Applicant’s Basic Annual Income	Other Annual Income P
P	Other Income Source (pls. check)
At least P120,000 per annum	Agriculture	Investment	Rental
Basic Annual Income is defined as the monthly basic salary x 13 months	Family Business	Royalty	Others (pls. specify)

TERMS AND CONDITIONS

I confirm that the information given by me is true and correct. I authorize Standard Chartered Bank to verify and investigate the information provided from whatever sources it may consider appropriate, including but not limited to the Bureau of Internal Revenue.

I understand that falsifying any of the information herein or on the enclosed documents is sufficient ground for legal action and the rejection of my application. By signing on my Credit Card, I signify my agreement to the Standard Chartered Bank Terms and Conditions for Credit Cards. If this application is denied, I acknowledge that the Bank is not obliged to provide the reason for denial or to return any document.

I understand further that the instructions, requests and other correspondences and documents sent (or purportedly sent) by me to the Bank through facsimile shall be considered valid and blinding and that the Bank may act upon instructions conveyed through this method. The Bank shall be entitled (but not bound) to take such steps in connection with or in reliance upon such communication as the Bank may in good faith consider appropriate. The Bank may use copies or facsimile transmissions as evidence in any court of law.

I also confirm that I have read, understood and accept the applicable Interest, other Fees and Charges as provided in this application form.



SIGNATURE OF PRINCIPAL APPLICANT		DATE

BALANCE TRANSFER

	Avoid further high interest fees! Transfer balances from other Credit Card and pay as low as P922* per month.
	*For as low as P30000 transaction @ 48 months tenor. Maximum amount subject to 90% credit limit.
	Apply now Yes No

EZ BILLS AUTO DEBIT CHARGING FACILITY

	Enroll your Cablelink* , Globe**, Meralco, Piltel, PLDT, Smart bills and Sun Life insurance premiums in EZBills and enjoy the ultimate convenience of living the life just the way you like it.
	Open to Bacoor, Las Pinas, Muntinlupa, Paranaque and Taguig Cable subscribers *Initially open to Globe handyphone accounts only
	Apply now Yes No

FOR BANK USE ONLY

Print and fax this form to 830-1156 / 878-2026