WHOLESALE INDIVIDUAL APPLICATION FORMProgram Branch Wholesale - Private Branch Wholesale - Government FOS Wholesale - Private * FOS Wholesale - Government Others MY PERSONAL DATA My Choice of Metrobank * Classic Visa / MasterCard M Free MasterCard (HRP) If we cannot process your request for your chosen * YES: NO Card Metrobank Card, would you accept another card type? please specify Card Company 16-digit Card Number Credit Limit Member Since My Other MCC Card Info Card Company 16-digit Card Number Credit Limit Member Since My Other Credit Card Info Last Name Given Name Middle Name Applicant Name Longakit Jay Ruel Sarona MM DD YYYY 7 3 ### * Single Widowed Gender * Male Female Civil Date of Birth Status Married Separated Nationality * Filipino Others: _______________ Place of Birth (Foreigners, attach ACR or ICR) Last Name Given Name Middle Name MM DD YYYY Name of Spouse Block Date of Spouse's (If applicable) 25 Birth (If applicable) Lot Mobile Phone Number 1 ### Home Phone Number 1 26 Mobile Phone Number 2 Deut ### Home Phone Number 2 eron Email Address
[email protected] Mother's Maiden Name omy Stree Present Home Address t, 8000 Emily Hom Permanent Home Address (If Different from Present Home Address) es, Zip Code: ________ Caba Home Ownership ntian Owned Rented Mortgaged * Living with Parents Length of Stay: _______________________________ , Education Dava * College High School Some College Post Graduate Vocational o Tax Identification Number City SSS or GSIS Number Source Of Funds * Employment * Investments Retired (Pension, etc) Self Employment / Business Others: ____________________________ Company Name RM LED Lights Corporation Nature of Business Lights Sales Agent Office Phone Office Phone Level / Position Local: ________ Local: ________ Number 1 Number 2 Business Address Km 10 Plain View Village Sasa Davao City Zip Code: ________ MM DD YYYY Total Years Working 1 YEAR * Regular Project Based 5 15 2016 Employment Date of Hire Gross Annual 11,500 Status Probationary Contractual Years with present employer Income MY SUPPLEMENTARY DELIVERY INSTRUCTIONS Supplementary Cardholder must be 14 to 80 years old. Supplementary card applicants are required to submit a photocopy of a valid government- DELIVER CARD & issued ID and complete the fields marked (*). The spending limit given to the Supplementary Cardholder is part of the Principal’s credit limit. If the STATEMENT TO: * Home Business spending limit indicated is greater than the approved credit limit, the spending limit to be given to the Supplementary Cardholder will be the same as (choose one) the approved credit limit. Last Name Given Name Middle Name No Is this a condominum? Yes Supplementary Name Longakit Emersilly Sarona I want to receive my Yes Email: statements via Email Home Address Block 25 Zip Code: ____8000____ Lot M26M DD YYYY Deutero Relation to PREFERRED PAYMENT METHOD nomy 3 16 1974 Date of Birth Street, Principal Mother I will pay in cash or check at a Metrobank branch/PSBank branch/other payment channels * Emily Applicant Homes, Place of Birth Cabanti Gender an, Male * Female Nationality Filipino Automatic Debit Arrangement (ADA) Davao City Home Phone Please debit my Peso current/savings account no: ______________________________ Mobile Phone Number Number at Metrobank __________________________________________________ branch. Assigned Monthly 100% of Principal's Credit Limit Php: Minimum Amount Due Spending Tax Identification SSS or GSIS Full Amount Due Number Number UNDERTAKING I would like to avail of the Metrobank Credit Card offered under the Metrobank Card Corporation's Wholesale Program. I hereby authorize my employer to provide /confirm to Metrobank Card Corporation my information necessary to facilitate my credit card application. In the event of approval of my application for the Metrobank Credit Card, I hereby agree to be governed by the TERMS AND CONDITIONS (made an integral part of this undertaking) of the use of the Metrobank Credit Card which mayl be issued to me and which I may receive, as evidenced by my signature hereof, and/or the signature of my representative. My use of the card shall constitute proof that I have read and fully understood the TERMS AND CONDITIONS enclosed and delivered with the card and that I consent to be bound under such. I agree, further, to hold MCC card and harmless from any and all liabilities that I will incur with the use of the Metrobank Credit Card. I further hold myself liable for all obligations andliabilities that I will incur with the use of the Metrobank Credit Card which may be issued to me. DECLARATION I/We hold myself/ourselves liable for all obligations and liabilities incurred with the use of the Metrobank Credit Card/s issued to me/us. I/We warrant that, I/We shall be jointly and severally liable for the same obligations and that I/we hereby commit myself/ourselves to the following declarations: (1) I/we certify that the foregoing facts are true and correct; (2) I/we authorize METROBANK CARD CORPORATION (A FINANCE COMPANY)[MCC] to receive and exchange any and all information concerning myself/ourselves with other financial institutions, entities tasked to provide consumer credit reporting or reference schemes, the appropriate government agencies and third parties to whom MCC may reasonably share such information; (3) I/we authorize MCC, to acquire any information from Metrobank and PSBank to facilitate the approval of my credit card application as well as all credit card transactions, e.g., cash advance, increase in credit limit, etc. initiated upon my/our own initiative and in the event of default arising from non-payment of credit card obligations with MCC; (4) I/we authorize MCC, it’s authorized representative/s and/or agent/s to verify and investigate these facts from whatever source it deems appropriate; (5) I/we understand that should my/our credit card application be denied, MCC has no obligation on its part to furnish the reason for such rejection except when the denial is based on credit data from CIC used in the evaluation of my/our application; (6) I/we agree that by calling MCC or any of its service providers, MCC or its service providers may, at its sole option and discretion, tape or record all my/our telephone communications. I/We likewise agree that such taped or recorded communications or transactions may be used by MCC or its service provider against me/us or any third party, replayed or communicated to any third party, for any purpose, including as evidence in any proceeding; and (7) I/we agree to the TERMS AND CONDITIONS governing the issuance of Metrobank Credit Card. This further serves as a waiver of confidentiality of all personal information that I/we have provided and authorizes MCC to conduct random verification with the BIR in order to establish authenticity of my ITR and the accompanying financial statements I submitted. Signature of Applicant Date TABLE OF FEES AND RATES Classic Mastercard / Visa M Free Mastercard ON Internet MasterCard * YES! I Want a Metrobank ON Internet MasterCard Annual Fee Php 1,500 / Php 800 Perpetually Waived Php 500 / Php 250 Principal / Supplementary Waived on 1st Year Waived on 1st Year Email Address: Mobile Number: Retail Monthly Effective Rate 3.54% based on actual calendar days. The Metrobank ON Internet Mastercard is the credit card for all your intenet Cash Advance Monthly Effective Interest PHP600 or 3% of the cash amount availed, whichever is higher. Not applicable transactions. This card enables you to shop more securely online. It is designed for Rate Additional PHP500 if transacted over-the-counter. non face-to-face transactions, giving you greater security and peace of mind. Cash Advance Fee PHP600 or 3% of the cash amount availed, whichever is higher. Not applicable Additional PHP500 if transacted over-the-counter. Online Security Late Payment Fee PHP 750 or 7.5% of the minimum amount due, whichever is higher. Your Metrobank ON Internet MasterCard is a more secure payment solution for all Over Credit Limit Fee PHP700 (M Free) / PHP500 (Classic, ON) per occurrence. your internet transactions. It is automatically enrolled to Secure Online Shopping PHP200 or an amount equivalent to the credit balance, whichever is lower will be charged to One Time (SOS-OTP) which means that when you use your Metrobank ON Internet Account Maintenance Fee accounts with credit balance that are closed or with no activity for the past 12 months. MasterCard at participating online merchants, you will receive a SOS-OTP on your mobile phone. Installment Pre-Termination Fee 5% of the remaining principal balance or P500 whichever is higher. Not applicable Gaming Fee 5% of the amount transacted. Paperless Statements Receive your monthly statement of account via your nominated email address. Statement Reprinting Fee P100 per request for reprinting and delivery of monthly statement. ON Rewards Program Returned Check Fee PHP1,500 for every returned check. Earn rewards points each time you use your Metrobank ON Internet MasterCard. Earn one (1) point for every P 20 you spend on your card which you can Multiple Payment Fee P50 for each payment made to Metrobank Card in excess of two (2) within a calendar month. accumulate and use to redeem online shopping credits. Every 10,100 points is equivalent to P 500 shopping credits. Cash2Go Processing Fee P100 will be charged for every Cash2Go transaction. Not applicable Balance Conversion Processing Fee P100 will be charged for every Balance Conversion transaction. Not applicable All charges, advances or amounts in currencies other than Philippine Peso (Php) shall be converted to Php based on MasterCard's / VISA's currency conversion rate at the time of posting and charged Signature of Applicant Date MasterCard's / VISA's assessment fee plus 2.50% processing fee, the rate of which may be adjusted Foreign Currency Transactions from time to time. The assessment 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 / VISA and / or the acquiring bank and / or foreign merchant affiliates.