Standard Chartered Bank - Application Form

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 __-__ __-__ __ __-__ __ __ __ __

SUPPLEMENTARY CARD DETAILS

The Supplementary cardholder must be at least 16 years old.

Supplementary cardholders not living with the applicant must submit one valid ID card. The Bank reserves the right to require additional documents to process the application.

To request for a list of acceptable IDs or to apply for more supplementary cards, kindly call 830-1111.

	Date of Birth					Place of Birth
		mm	dd	yy

Nationality

Filipino Other

Sex

M F

Relationship to Primary Applicant (Please check one)
Spouse	Son/Daughter	Parent	Brother/Sister	In-law: parent, child, sibling	Other
Living with Principal Applicant YES NO

SUPPLEMENTARY CARD DETAILS


	The Supplementary cardholder must be at least 16 years old. Supplementary cardholders not living with the applicant must submit one valid ID card. The Bank reserves the right to require additional documents to process the application. To request for a list of acceptable IDs or to apply for more supplementary cards, kindly call 830-1111.

	Date of Birth					Place of Birth
		mm	dd	yy

Nationality

Filipino Other

Sex

M F

Relationship to Primary Applicant (Please check one)
Spouse	Son/Daughter	Parent	Brother/Sister	In-law: parent, child, sibling	Other
Living with Principal Applicant YES NO

SUPPLEMENTARY CARD DETAILS


	The Supplementary cardholder must be at least 16 years old. Supplementary cardholders not living with the applicant must submit one valid ID card. The Bank reserves the right to require additional documents to process the application. To request for a list of acceptable IDs or to apply for more supplementary cards, kindly call 830-1111.

	Date of Birth					Place of Birth
		mm	dd	yy

Nationality

Filipino Other

Sex

M F

Relationship to Primary Applicant (Please check one)
Spouse	Son/Daughter	Parent	Brother/Sister	In-law: parent, child, sibling	Other
Living with Principal Applicant YES NO

PRINCIPAL CARDHOLDER INFORMATION

Birthdate				Home Phone Number	E-mail Address	Mother's Full Maiden Name

	mm	dd	yy			FIRST	M.I.	LAST

FEES



	Annual Fee Enrollment Fee	P600 Waived

TERMS AND CONDITIONS

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

I understand that falsifying any of the information on the enclosed documents is sufficient ground for legal actions and the rejection of my application. By signing at the back of the card when delivered to me, I signify my agreement to the Standard Chartered Bank Visa and MasterCard Terms and Conditions accompanying said card I understand that should my application be denied Standard Chartered Bank has no obligation on its part to furnish the reason for such rejection nor to return the application and other submitted documents.

I understand further that the Bank is entitled to treat fax request/ documents as fully authorized by cardholders and binding. The Bank shall be entitled to, but not bound, to take such steps in connection or in reliance upon communication as the Bank, may in good faith, consideration.

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

The supplementary card(s) and monthly billing statements will be delivered to the billing address of the principal cardholder.

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	SIGNATURE OF PRINCIPAL APPLICANT	DATE

FOR BANK USE ONLY

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