lOMoARcPSD|43079747

Application for Mcgcdd

Business Administration (Lyceum of the Philippines University)

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 lOMoARcPSD|43079747

FOR BANK’S USE ONLY

APPLICATION TO PURCHASE MC/GC/DD

Branch ____________________________________ ____________________________________ Date
Applicant’s Name CIF No.
(For Bank’s Use Only)
GF JIREH INC
Address Date of Birth / Contact No.
For Non-China Bank Incorporation
Accountholders 8373-9651

Purpose of Purchase ■ Manager’s Check (MC) Gift Check (GC) Demand Draft (DD)
Payment for Business Permit Renewal
Fifty-Three Thousand Six Hundred Seventy-Nine and Twenty-One Cents Only
Currency and Amount (in Words) PHP (in Figures) 53,679.21

Payee Name CITY TREASURER OF QUEZON CITY

Address QUEZON CITY

Total Amount to be Paid Exchange Rate (if applicable)

Mode of Payment: MC/GC/DD (Principal Amount) Service Charge (if MC/GC/DD Amount and Service
Charge are of the same currency)
■ Debit Account No.: Debit Account No.:
141-0688-710
____________________________ ____________________________
Equivalent Amount
Cash PHP ___________ (Currency) Cash PHP ___________ (Currency)

CBC On-us Check/MC No.: CBC On-us Check/MC No.:

____________________________ ____________________________

TERMS AND CONDITIONS

1. The Applicant(s) represent(s) and warrant(s) that the information indicated on this form are true and accurate, the funds originate from genuine transactions, and the Applicant(s)
has/have the requisite power or corporate authority to execute the transaction and that the payee is an existing person or entity.
2. Payment of the MC/GC/DD herein is qualified by and conditioned upon receipt by the addressee branch/correspondent of the correlative advice/instruction from the issuing office.
3. Refund, if requested by the Applicant(s), may be made at the discretion of the Bank, but only if, and after, the Bank has received confirmation of effective cancellation of the payment,
and/or all original copy of the MC/GC/DD issued are surrendered to the Bank and still outstanding. For Demand Draft, in case of funds already converted, refund shall be made at the rate
which the Bank may fix, less applicable expenses of the Bank, its correspondents, agents, and sub-agents.
4. In the event the MC/GC/DD is lost, stolen, or destroyed, the Bank reserves the right to impose/require, for its protection, any condition and/or a bond of indemnity or any other sufficient
security acceptable to it before issuing a replacement for the lost instrument(s) or refund thereof.
5. Any MC/GC/DD is issued with the distinct understanding that it will be forwarded immediately for presentation to the drawee. The Bank will not be responsible should the MC/GC/DD be
dishonored as a result of delay in presentation or late arrival or non-arrival of advice of drawing or any other reason beyond the Bank's control.
6. I/We affirm that each of the statements made in this application is true and correct and the signature(s) appearing herein is/are genuine. I/We further affirm that I/we have provided the
necessary information in order for China Banking Corporation (CBC) to accurately determine whether or not the product or service is appropriate. I/We agree to notify CBC of any
changes affecting the information contained herein.
I/We hereby waive the confidentiality accorded by RA No. 1405 Secrecy of Bank Deposit Act, as amended, RA No. 6426 Foreign Currency Deposit Act of the Philippines, as amended,
RA No. 8791 General Banking Law of 2000, as amended, RA No. 9160 Anti-Money Laundering Act of 2001, as amended, and other similar and applicable laws, pursuant to Sec. 26 of
RA No. 7653, The New Central Bank Act and Sec. X337 of the BSP Manual of Regulations for Banks, and allow examination, inquiry, inspection, and investigation of my/our deposits of
whatever nature, photocopying of my/our documents, maintained with CBC and in all banks in the Philippines. However, any information obtained from an examination of my/our deposits
shall be held strictly confidential and may be used by the examiners only in connection with their supervisory and examination responsibility or by the BSP in an appropriate legal action it
has initiated involving the accounts.
I/We hereby consent and/or was authorized to give consent to the collection, retention, processing (as provided under applicable confidentiality and data privacy laws of the Philippines
including all subsequent amendments or supplements thereto), and disclosure by CBC, of any personal, sensitive personal and privileged information relating to me/us, my/our
surety(ies), third party mortgagor(s), my/our authorized person(s), whether provided by me/us or coming to CBC’s possession, for purposes of loans and/or credit accommodations and/or
any of its existing credit facilities, or any other present or future credit transactions or arrangements that I/we may have with CBC, its subsidiaries and affiliates. I/We further consent to the
sharing and disclosure (and incidentally, their collection, processing, retention and disclosure), of such personal, sensitive personal and privileged information by CBC to its offices,
branches, subsidiaries, affiliates (ChinaBank Insurance Brokers, Inc., China Bank Securities Corporation, China Bank Capital Corporation, ChinaBank Savings, Inc., China Bank
Properties and Computer Center, Inc., and Manulife-China Bank Life Assurance Corporation, among others), accredited third parties/vendors, or other persons or entities that CBC may
reasonably select, personal information processors, government agencies and private regulatory organizations and other financial institutions and other outsourced service providers
engaged by the Bank as allowed by law and internal Bank policies, for purposes reasonably required by CBC such as, but not limited to, its conduct of everyday business (processing
my/our transactions, maintenance of my/our account/s), performance of daily technological and operational functions, communications technology services including updates and
automation of the systems of CBC group and its subsidiaries and affiliates, compliance with the law and regulatory organizations, statistical and risk analysis, and all other purposes as
allowed in the banking industry practice, businesses of CBC’s subsidiaries and affiliates, and by law. I/We shall notify CBC in writing, which must be acknowledged by CBC, if I/we do not
consent to the processing and disclosure of the said information with CBC’s representative offices, subsidiaries, affiliates and agents or other persons or entities that CBC may reasonably
select. I/We further acknowledge my/our right to information, access, correction, rectification, erasure of my/our personal, sensitive personal and privileged information, data portability,
objection to processing, file complaint and damages under the Data Privacy Act.
Relative to the above, I/we agree that CBC may retain my/our personal and account information for as long as necessary for the fulfilment of the purpose for which it was collected and
such other purposes that I/we may have consented to from time to time, or as required by pertinent laws and regulations, and provide information when required to do so in accordance
with RA 1405, RA 6426, RA 8791, RA 9510, RA 9160, RA 10173, as amended, and other similar and applicable laws, by court order, and jurisprudence.
I/We agree that CBC shall not be liable for any loss or damage arising from CBC’s disclosure of personal and account information for the above purposes.
If I/we provide CBC with any personal information relating to a third party (e.g. my/our references, suppliers, customers, et.al.), I/we warrant to CBC that I/we have obtained the
written/recorded consent of such third party to provide CBC with his/her personal information for the necessary credit checks and other relevant purposes.
I/We fully understand that any material misrepresentation or failure to disclose information on my/our part as required herein may cause disapproval of my/our application; and CBC at any
time, shall have the right to cancel the approval. I/We acknowledge that I/we have been informed by CBC of the Terms and Conditions regarding my/our application to purchase
MC/GC/DD including its current fees and charges being imposed.
I/We agree to indemnify and hold free and harmless CBC, its subsidiaries and affiliates, as well as any of its officers, directors and employees against any and all losses, claims,
damages, penalties, liabilities, choses of actions and costs of any kind that may arise directly or indirectly from the execution of this application to purchase MC/GC/DD.
In signing this application, I/we confirm that I/we agree with the Terms and Conditions which I/we have read and understood. Furthermore, I/we acknowledge that I/we have been properly
informed by the Bank of the Terms and Conditions regarding the application to purchase MC/GC/DD including its current fees and charges being imposed. If payment is to be debited from
my/our deposit account, this will serve as the Bank’s authority to debit the above-cited account for payment of MC/GC/DD Amount (including service charge if applicable). I/We declare under
penalties of perjury that my/our co-depositor(s) is/are still living.
AUTHORITY TO CLAIM (Cross-out this section if not applicable.)
This is to authorize my/our representative whose name and signature appear
below to claim the MC/GC/DD in my/our behalf.

RUBY GATCHALIAN CATHERINE GATCHALIAN

Applicant(s)’s / Authorized Signatories’ Signature Over Printed Name(s) / Date Authorized Representative’s Signature Over Printed Name / Date
MC/GC/DD No. Processed By Approved By

BNK-086 (09-22) TMP

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