BPI Express Credit Corporate Card – Cardholder Information Sheet
COMPANY NAME: Avon Cosmetics, Inc
ADDRESS: C/O 9/F Gercon Plaza Bldg., 7901 Makati Avenue Makati City
CARDHOLDER INFORMATION
Name
(Last) (First) (Middle)
Name to appear on card (Must not exceed 23 characters, including spaces; aliases/nicknames are not acceptable)
Position in the Company Employee No.
Mother’s Full Maiden Name
Birthdate (mm/dd/yy) Place of Birth Sex Male Female
Citizenship TIN (Tax Identification Number)
Filipino Non-Filipino (please specify) ___________
CONTACT INFORMATION
Cellphone No Best Time To Call: AM PM Office Telephone No Best Time To Call: AM PM
Home Phone Number/s Best Time To Call: AM PM Email Address
Home Address
House/Unit No. Street Village/ Brgy./ Municipality City/ Province Zip Code
Permanent Office Address
House/Unit No. Street Village/ Brgy./ Municipality City/ Province Zip Code
Alternate Office Address (if any)
House/Unit No. Street Village/ Brgy./ Municipality City/ Province Zip Code
In connection with the issuance of the BPI Express Credit Corporate Card, the Company may enroll in the Express Data Online (EDOL) facility, which will give the Company
the option to view online the Cardholder’s transaction details.
The cardholder further understands and agrees that in the event of the Company ’s failure to pay, the obligations, charges and liabilities incurred through the use of the
BPI Express Credit Corporate Card issued to its employees, or any portion thereof, the Cardholder expressly allows BPI to withdraw, cancel or suspend at anytime thereafter
any or all of the BPI Express Credit Corporate Card privileges and holds BPI free and harmless and indemnified from any and all claims, damages, suits, and causes of
action arising from such withdrawal, cancellation or suspension.
By signing below, the Cardholder agrees to and shall be bound by the terms and conditions herein. The Cardholder further authorizes the Company to receive copies of
and/or view online the Cardholder’s SOA.
Please submit a Proof of Identification to complete your corporate credit card application.
Proof of Identification (Government Issued ID: Driver’s License, Passport, Voter’s ID, SSS/Philhealth ID)
_____________________________ _____________________
CARDHOLDER’S SIGNATURE DATE
As of 5.7.14
BPI Express Credit Corporate Card – Cardholder Information Sheet
I am also interested in applying for a Personal BPI Express Credit Card!
Please choose your preferred Card:
BPI Blue MasterCard BPI SkyMiles MasterCard* BPI Amore Visa
BPI Gold MasterCard BPI SkyMiles Platinum MasterCard* BPI Amore Visa Platinum
Petron-BPI MasterCard
BPI Edge MasterCard *Existing Skymiles members may submit a photocopy of ANY of the following:
BPI eCredit - Skymiles ID
(Free Companion Card for BPI - Latest E-mileage summary
- Any Skymiles membership document
MasterCard card variants)
ADDITIONAL INFORMATION
Civil Status No. of Dependents SSS/ GSIS Number
Single Married
Separated Widow(er)
Home Ownership Car Ownership
Owned Rented Php _______/ month No. of cars owned _____
Living with Parents Mortgaged Php ______/ month Owned
Living with Relatives Mortgaged Php ______/ month
Years of Stay ___________
Kindly indicate if you’re related to a BPI Director, Officer, Stockholder, and Related Interest (DOSRI) :
Full Name: Relationship: Parent Parent in law Spouse Children
FINANCIAL INFORMATION
Source of Income / Funds:
Salary(S) Interest/ Commission (C) Business (B) Others (please specify) _______
Employment Type Gross Annual Income
Employed Self-employed Others ______
Nature of Business/ Industry Years with Present Employer/ Business
Previous Employer Years with Previous Employer/ Business
BANK RELATIONSHIP
MY OTHER CREDIT CARD (S)
CREDIT CARD CARD NUMBER CREDIT LIMIT EXPIRY
_ ______ ____ _ _____ _______ _____ _ __ _____ _ _ __
______ ____ _ _____ _______ _____ _ __ _____ _ _ __
SPOUSE DETAILS
Name
(Last) (First) (Middle)
Birthdate (mm/dd/yy)
Please submit the following requirement(s) to complete your personal credit card application:
Proof of Income (Any of the following: Certificate of Employment, Latest payslips, Latest Income Tax Return)
By signing below, I (We) confirm/agree that a (1) the statements made in this application and the information and supporting documents provided by me (us) are true,
correct and accurate; (2) any material misrepresentations or falsity or omission herein will be construed as an act to defraud BPI and may be a ground for the denial of
my (our) application or, if already granted, authorize BPI to restrict the use of and/or terminate / cancel the Card without need of prior notice to Cardholder, without
prejudice to such civil and/criminal liability that BPI may pursue against me (us); (3) it is the sole prerogative of BPI to grant or deny this application and should my
(our) application be denied, BPI has no obligation to provide me (us) the reason for such decision; (4) all statements/information/documents/forms obtained by BPI shall
remain the property of BPI whether or not my application is granted; (5) BPI may impose such other terms, conditions and requirements as it may deem necessary or
proper after satisfactory credit investigation and approval of this application; (6) I (we) shall notify BPI of any material changes affecting the
statements/information/documents/forms provided by me (us) in this application; (7) I (we) may receive updates, notices and announcements regarding my (our)
application, and/or Card via SMS/text, email or fax transmission or such other means of communication deemed appropriate by BPI; (8) BPI may enroll the approved
application with any credit protection provider or guarantee program of any institution, whether public or private, at BPIâs sole option; (9) BPI may verify and investigate
any statements/information provided in this application or otherwise, from whatever sources it may consider appropriate; (10) this [Declaration] applies to and covers
any and all credit facilities granted by BPI to me (us) from time to time, including any subsequent renewals, extensions, increases, amendments and/or conversions
thereof. In the event that my (our) application is approved, my (our) signature below and/or my (our) use of the Card shall be deemed my (our) acceptance/agreement
with the terms and conditions governing the issuance and use of the BPI Express Credit Card which are printed, in this application form and/or at the back of the Card
carrier which I (we) will receive together with my Card. I acknowledge that said terms and conditions (which may be amended or supplemented by BPI from time to
time) may likewise be viewed in the BPI Cards website. I (we) accept liability for all charges to the principal card and supplementary cards. Any alteration, amendment,
exception, reservation or scribbling made by me herein, in the BPI Express Credit Card terms and conditions, as well as in the provisions contained in the Statement of
Account (SOA), Installment Plan Contract, Charge Slip, other documents, Suretyship Agreement and/or such other related instruments or docume nts, not approved in
accordance with BPIâs appropriate procedures, shall not be valid and binding.
_____________________________ _____________________
CARDHOLDER’S SIGNATURE DATE
Bank’s Use Only:
CBD Account Officer Reference Code Doc. Image No.
DSIAC000
As of 5.7.14
