Form CC Boc
Form CC Boc
BIRTHDATE (mm/dd/yyyy) PLACE OF BIRTH NATIONALITY CITIZENSHIP MOTHER’S FULL MAIDEN NAME NO. OF DEPENDENTS
Bldg. / House No. Street / Brgy. District / Town City / Province Zip Code
PERMANENT ADDRESS SSS / GSIS
Bldg. / House No. Street / Brgy. District / Town City / Province Zip Code
_________________________________________________ _____________________________________________________
The mobile number indicated herein will be used for sending TYPE _____________________________________
HOME PHONE NUMBER The email address indicated herein will be used for sending your
your balance, cardholder updates/ notices, security alerts, one electronic Statement of Account (E-Statement), cardholder
NUMBER ______________________________________
-time-password, promotional information, etc. updates/ notices, security alerts, promotional information, etc.
Bldg. / House No. Street / Brgy. District / Town City / Province Zip Code
EMPLOYMENT TYPE POSITION INDUSTRY / BUSINESS TYPE FUNDS / AVE. MONTHLY INCOME
Government Senior Management Director Real Estate Banking and Finance Education Under P10,000
Private
Retired Executive Supervisor Manufacturing Insurance Mining P10,000 - P19,999
Self-Employed
Non-Officer Professional Retail / Wholesale Utilities Entertainment P20,000 - P49,999
Others:
_______________________________ Teaching / Educational Sales Agriculture / Forestry Transport / Shipping BPO P50,000 - P99,999
Others:__________________________________ Hotel / Restaurant IT / Telco Others: P100,000 - P249,999
PROFESSION RANK Government Construction ___________________ P250,000 and above
Medical Travel Related
GROSS ANNUAL INCOME OTHER INCOME SOURCE OF FUNDS DO YOU OWN A CAR?
Salary Pension Donation Yes, how many? ______________ No
Business Remittance Interest
Others:__________________________________________________ ( ) Owned ( ) Mortgaged ( ) Company Leased
DEPOSIT ACCOUNT WITH BANK OF COMMERCE ARE YOU A BANKCOM CREDIT CARD HOLDER? OTHER CREDIT CARD OTHER CREDIT CARD
Branch ______________________________ Yes No Issuing Bank _________________________________ Issuing Bank _________________________________
Type of Account ______________________________ Card Number _________________________________ Card Number _________________________________ Card Number _________________________________
Balance ______________________________ Credit Limit _______________Year Issued __________ Credit Limit _______________Year Issued __________ Credit Limit _______________Year Issued __________
SPOUSE INFORMATION
TITLE LAST NAME FIRST NAME MIDDLE NAME
Mr. Mrs. Ms.
BIRTHDATE (mm/dd/yyyy) CITIZENSHIP EMAIL ADDRESS MOBILE NUMBER Prepaid Postpaid Employed
Self-Employed
NAME OF OFFICE / BUSINESS OFFICE ADDRESS ZIP CODE OFFICE PHONE NUMBER YEARS WITH PRESENT
EMPLOYER
RELATIONSHIP TO GOVERNMENT OFFICIAL (1st degree of consanguinity and affinity) (Please use another sheet if necessary)
NAME RELATIONSHIP HIGHEST POSITION OCCUPIED PERIOD COVERED
The corporate logo of San Miguel Corporation is a registered trademark of San Miguel Corporation, and is used under license.
SUPPLEMENTARY CARDHOLDER INFORMATION (Applicant must be at least 15 years old) Not Applicable for Cash Installment Card
SUPPLEMENTARY CARD
LAST NAME FIRST NAME MIDDLE NAME GENDER
Male Female
Name to appear on the card (Limited to 19 characters including spaces) TIN
BIRTHDATE (mm/dd/yyyy) PLACE OF BIRTH NATIONALITY CITIZENSHIP RELATIONSHIP TO PRINCIPAL CARDHOLDER SSS / GSIS
Bldg. / House No. Street / Brgy. District / Town City / Province Zip Code
PERMANENT ADDRESS YEARS OF STAY HOME PHONE NUMBER
Bldg. / House No. Street / Brgy. District / Town City / Province Zip Code
EMPLOYMENT TYPE POSITION INDUSTRY / BUSINESS TYPE FUNDS / AVE. MONTHLY INCOME
Private Government Senior Management Director Real Estate Banking and Finance Education Under P10,000
Self-Employed Retired Executive Supervisor Manufacturing Insurance Mining P10,000 - P19,999
Others: Non-Officer Professional Retail / Wholesale Utilities Entertainment P20,000 - P49,999
_______________________________ Teaching / Educational Sales Agriculture / Forestry Transport / Shipping BPO P50,000 - P99,999
Others:__________________________________ Hotel / Restaurant IT / Telco Others: P100,000 - P249,999
Government Construction ___________________
PROFESSION RANK P250,000 and above
Medical Travel Related
MOTHER’S FULL MAIDEN NAME SPOUSE NAME
RELATIONSHIP TO GOVERNMENT OFFICIAL (1st degree of consanguinity and affinity) (Please use another sheet if necessary)
NAME RELATIONSHIP HIGHEST POSITION OCCUPIED PERIOD COVERED
Sub-limit assignment begins at a minimum of P5,000 and increments of P5,000. The sub-limit given to the Supplementary cardholder is part of CREDIT LIMIT TO BE ASSIGNED (SUBLIMIT)
the Principal cardholder’s credit limit. The maximum spending limit of the Supplementary cardholder shall not exceed the approved credit limit of
the Principal cardholder. If no sub-limit is indicated, the default will be 100% of Principal cardholder’s credit limit.
DELIVERY AND MAILING INSTRUCTIONS MODE OF PAYMENT (If Account Number is not provided, payment mode is “Pay to Bank”)
MAILING ADDRESS Pay to Bank Auto Debit my Account (ADA)
Deliver my Bank of Commerce Credit Card to my: Auto Debit my BankCom Peso Account No.
Full Amount Due
HOME ADDRESS BUSINESS ADDRESS
Minimum Amount Due
Deliver my Bank of Commerce Credit Card Statement of Account to my:
Auto Debit my BankCom Dollar Account No.
HOME ADDRESS BUSINESS ADDRESS EMAIL ADDRESS
Full Amount Due
E-STATEMENT FACILITY AND NOTICES Minimum Amount Due
IMPORTANT:
By choosing to receive my statement of account thru my email address stated, I will no longer receive paper The BankCom deposit account must be under the Applicant’s name.
copy thereof and I hereby authorize Bank of Commerce to enroll my Credit Card account in Bank of Commerce Default will be MINIMUM AMOUNT DUE if no selection has been made.
E-Statement Facility.
TERMS AND CONDITIONS FOR ADA ENROLLMENT
By signing up for and/or using the E-Statement Facility, I accept and agree to be bound by all operational rules
1. Payment under the ADA facility will be debited on actual due date as indicated in my Statement of Account.
and general terms and conditions governing the Bank of Commerce Credit Card E-Statement, which can be
found at the Bank’s website at www.bankcom.com.ph. 2. The authority under this ADA shall remain valid with respect to replacement card without prejudice to the right of
the Bank to require a new ADA.
If no email address is provided, a paper copy of the Statement of Account will be sent to the declared billing 3. Should the Bank fail to implement this ADA for three (3) consecutive billing cycles for reason not attributable to
address. the Bank, the Bank may, without need of notice, disenroll the Account from the ADA facility.
For notices including amendments in the terms and conditions that will result to fees to be paid or charged to my 4. The authority under this ADA shall continue to be effective until the Bank receives a duly accomplished ADA
account, I prefer notification via: ( ) email ( ) text message cancellation request at least seven (7) banking days prior to the intended date of cancellation.
Minimum Amount Due 5% of the Total Outstanding Balance or Php500 whichever is higher (Peso billing); or 3% of the Total Outstanding Balance or USD50 whichever is high-
er (Dollar billing). The minimum amount due consists of the following: (a) a % of the Total Outstanding Balance inclusive of all fees and charges, (b) past
due amount, (c) monthly installment amount; and (d) any amount in excess of the credit limit. The minimum amount due is the sum of (a), (b), (c) and (d)
or P500/USD50, whichever is higher.
Charge Slip Retrieval Fee Php300 for local and USD6 for international purchases
Overlimit Fee Php700 or USD12 when outstanding balance Php700 when outstanding balance
Php700 when outstanding balance exceeds credit
exceeds credit limit (transactions plus interest and exceeds credit limit (transactions plus
limit (transactions plus interest and fees)
fees) interest and fees)
Quasi Cash Fee 5% of the transaction amount/ quasi cash transaction
SOA Re-print Fee Php100 per re-print request of SOA
Refund Fee Php500 per request (refund for over payment only)
Multiple Payment Fee Php50 for each payment in excess of 3 payments Php50 or USD1 for each payment in excess of 3 Php50 for each payment in excess of
within the same cycle from non-BankCom payments within the same cycle from non-BankCom 3 payments within the same cycle
payment channel. payment channel. from non-BankCom payment channel.
ADA (Auto Debit Arrangement) Php200 for every unsuccessful ADA processing Php200 or USD4 for every unsuccessful ADA Php200 for every unsuccessful ADA
Fee due to insufficient funds processing due to insufficient funds processing due to insufficient funds
Certification Fee
(Certification of full payment or Php300 per issuance of Certification of full payment or good credit standing
good credit standing)
*Applicable for Dual Currency Billing product
By signing this application or supplementary application below, I am applying for a Bank of Commerce credit card. I acknowledge and agree that by applying, or by calling to request for card activation, or by
signing or using my Bank of Commerce credit card, I understand and agree to be governed by the Terms and Conditions Governing the Issuance and Use of Bank of Commerce Credit Card and all future
amendments thereto, which can be found at Bank of Commerce website at www.bankcom.com.ph
I warrant that all information given in this application is true and correct. I authorize Bank of Commerce, its branches, units, affiliates, subsidiaries, authorized representatives and accredited third-party
partners to verify the information in this application and accompanying documents with the Bureau of Internal Revenue (BIR), any other appropriate government agencies or third parties to establish authentic-
ity of the information declared and documents submitted; to submit, disclose, share and exchange my basic credit data and the information about me to the Credit Information Corporation (CIC), other lenders
authorized by the CIC, credit reporting agencies duly accredited by the CIC pursuant to Republic Act No. 9510 and its implementing Rules and Regulations, to other government agencies or third parties to
process and evaluate my application for Bank of Commerce Credit Card; or to report/ request reports from consumer credit reporting reference schemes.
Acknowledging and exercising my rights under Republic Act No. 10173, otherwise known as the Data Privacy Act and its Implementing Rules and Regulations, I hereby give my consent to Bank of
Commerce and/ or its branches, units, agents, authorized representatives, representative offices, affiliates, subsidiaries, and accredited third-party partners, counterparties, correspondent banks and
service providers to process, use and share among themselves the personal information written on the application for credit card/ supplementary credit card as well as the information obtained in the
course of my transactions with Bank of Commerce, its branches or units in relation to my credit card, or obtained from third parties for purposes of client identification, client risk profiling/ assessment,
product development and improvement, market research, communications relevant to the life cycle or usage of my credit card, compliance with BSP rules and regulations, anti-money laundering laws,
rules and regulations, FATCA, and such other purposes as may be allowed by law.
I also acknowledge that my Personal Data (refers to ALL types of personal information - personal, sensitive and privileged as defined under the Data Privacy Act and its implementing Rules and
Regulations) shall be retained for a period of not less than five (5) years from the time my credit card is cancelled or terminated as required or allowed under applicable laws, rules and regulations, unless
a longer retention is necessary in view of any investigation being conducted, or a criminal, civil, or administrative case filed in a competent judicial or administrative body where I or my account is involved
or impleaded as a party to the case or investigation, in which cases, to the extent necessary, my Personal Data shall be preserved beyond five (5) year period until such time that a final judgement has
been reached by the judicial or administrative body.
I likewise hereby give my consent to Bank of Commerce and/or its branches, units, agents, authorized representatives, representative offices, affiliates, subsidiaries and accredited third-party partners,
counterparties, correspondent banks and service providers to offer especially selected products and services to me through mail, email, fax, SMS, or by telephone to ensure that I will have the opportunity
to avail of a wide range of products, services and facilities of Bank of Commerce, its subsidiaries and affiliates, third-party partners, counterparties, correspondent banks and service providers.
The foregoing constitutes my written, express, specific and informed consent for any transfer, disclosure or storage including cloud storage of my name, address, contact details, account balances and
numbers and other relevant information by and among Bank of Commerce and/ or its branches, units, agents, authorized representatives, representative offices, affiliates, subsidiaries, and accredited
third-party partners, counterparties, correspondent banks and service providers.
____________________________________________________
Applicant’s Name and Signature
In the event my application for Bank of Commerce Credit Card is disapproved, Bank of Commerce is under no obligation to provi de me with the reason for such a decision, unless required by law or
regulation. I understand that the application form and documents submitted to Bank of Commerce will be stored and kept within the retention period prescribed by the Bank and will not be returned for
whatever reason.
I hold myself liable for all obligations and liabilities incurred with the use of the Bank of Commerce credit card and supplementary card/s.
I agree and authorize the Bank to send any form of communication associated with its products to me, unless I expressly notify the Bank otherwise.
I hereby and undertake to inform Bank of Commerce immediately of any change in any information or declaration I made herein or in the documents/papers submitted by me. I expect Bank of Commerce to
respect my right to access and right to correction, erasure or blocking of my data that are incorrect or inaccurate.
I further understand that Bank of Commerce reserves the right to cancel the Bank of Commerce credit card without prior notice if it is later determined that the information being certified by me is false.
Upon demand by Bank of Commerce for payment of the card purchases, any money, deposit or other property of any kind whatsoever to the credit of my account in the books of Bank of Commerce in transit
or in its possession, may, without notice, be applied at its sole discretion, to the full or partial payment of Bank of Commerce credit card purchases. I irrevocably authorize Bank of Commerce, without
necessity of prior notice, to apply monies, deposits or other property of any kind whatsoever, to the payment of my indebtedness.
I hereby confirm and certify that I have read and understood the foregoing Applicant Undertaking and Declaration and hereby agreed to be bound thereof.
___________________________________________________________________ ___________________________________________________________________
PRINCIPAL APPLICANT’S SIGNATURE SUPPLEMENTARY APPLICANT’S SIGNATURE
The corporate logo of San Miguel Corporation is a registered trademark of San Miguel Corporation, and is used under license.
FOR BANK USE ONLY
PRINCIPAL CIF NUMBER SUPPLEMENTARY CIF NUMBER REFERRED BY BRANCH / SOURCE CODE DATE DOC. IMAGE NO.
For inquiries, call Bank of Commerce Customer Care Hotline: (02) 8-632-2265
Domestic Toll-Free numbers: (PLDT) 1800-10-982-6000 and (Globe Lines) 1800-8-982-6000
Or send us an email at customerservice@bankcom.com.ph
CCU 16-26 B (R09/24) The corporate logo of San Miguel Corporation is a registered trademark of San Miguel Corporation, and is used under license.