A4 - ATM Debit Card Form

CIF Number
(for internal use)

I. CUSTOMER INFORMATION

Full Name
Last Name First Name Middle Name Suffix

II. NEW ATM DEBIT CARD ACCOUNT INFORMATION

Do you want a Debit Card Yes

with your name on it?
No
(If yes, provide the name for
the card)

III. EXISTING ATM DEBIT CARD UPDATE INFORMATION

To maintain your ATM Debit Card account, provide the card number

What would you like to do with the ATM Debit Card account indicated?
Add Account/s Remove Account/s Delete Card
(Provide account numbers to be added) (Provide account numbers to be removed)

IV. CUSTOMER UNDERTAKING

Signature
By signing, I hereby certify that the information in this form is true and correct to the best of my Date Signed
knowledge. I undertake to advise BDO Group and provide documentation for any changes to the (mm / dd / yyyy)
above information.

/ /
V. CUSTOMER UNDERTAKING AND CONSENT FOR THE ISSUANCE OF ATM DEBIT CARD FOR MINORS
The undersigned parent/legal guardian hereby agrees to the issuance and use of the BDO ATM
Debit Card to and by the above-named minor accountholder. The undersigned is also aware and
understands that the BDO ATM Debit Card may be used in ATMs, Point of Sale (POS) Terminals and Signature
Online/Web Merchants. The BDO ATM Debit Card and the use thereof shall be subject to the BDO
Terms and Conditions Governing Deposit Accounts as well as the BDO ATM Debit Card Terms and Date Signed
(mm / dd / yyyy)
Conditions. The undersigned irrevocably holds BDO Unibank Inc., its directors, officers, employees
and assignees free and harmless from and shall indemnify them against any and all loss, damages,
liabilities, claims and suits that may arise in connection with the issuance and use of the BDO ATM / /
Debit Card.

VI. ATM DEBIT CARD ACKNOWLEDGMENT RECEIPT

Signature
Date Signed
(mm / dd / yyyy)
By signing, I / We confirm that I / We have received our ATM Debit Card.
/ /

Account Name Account Number (for new cards)

Branch Card Number (for new cards)

FOR I NT E RNA L U SE ON LY

Date (mm/dd/yyyy)

/ /

Card Type (If ‘Others’, please indicate) Verified and Card Released by
Name / Signature Date (mm/dd/yyyy)

Mastercard Junior Savers Prime Savers

/ /
Visa Kabayan Savings Others

Verified and Processed by Approved by Witnessed by

Name / Signature Date (mm/dd/yyyy) Name / Signature Date (mm/dd/yyyy) Name / Signature Date (mm/dd/yyyy)

/ / / / / /

For concerns, contact us thru our 24x7 hotline (+632) 8631-8000 or email us via [email protected].
BDO Unibank is regulated by the Bangko Sentral ng Pilipinas with contact number (+632) 8708-7087 and with email address [email protected]. REVISED AS OF NOVEMBER 2022
The BDO Unibank and other BDO-related marks are registered trademarks of BDO Unibank, Inc. All rights reserved.