CREDIT CARD REQUEST FORM

Please completely fill out all mandatory* information below.

CARDHOLDER DETAILS

CARDHOLDER’S NAME*:

CARD NUMBER*: EXPIRY DATE*:

UPDATED BILLING ADDRESS*:

HOME PHONE NUMBER*: OFFICE / BUSINESS PHONE NUMBER*: BEST TIME TO CALL*:
AM
FAX NUMBER*: MOBILE NUMBER*: 0 9 PM

E-MAIL ADDRESS*:

Increase in Credit Limit Lost Card

Please complete the following details: Card Number:
Nature of Business / Employment:
Position:
Card Reactivation
Gross Monthly Income:
Card Number:
BPI/BFB Accounts:
Bank: Account Number:
Card Activation (for newly issued cards that are deactivated upon delivery)
Credit Card/s with other bank/s:
Credit Card Company: Credit Card Number: Cardholder Name (Last, First, Middle) 16-Digits Card Number

Market Segment:

Permanent
Present Credit Limit
Requested Credit Limit
Temporary
Present Credit Limit
Requested Credit Limit
From (mm/dd/yyyy)
Cash Advance (over the counter)
To (mm/dd/yyyy)
Card Number:
Amount:
VS Hold Out Express Start (Client should sign new DOA)
Approval Code:
Current Amount on Hold
New Amount on Hold
Cash Advance PIN Request
Reallocation of Credit Limit Card Number:

Card Number
Present Credit Limit
Requested Credit Limit Link, Conversion, Replacement

Link Card
Decrease in Credit Limit CARD TYPE REQUESTED:
Card Number REGULAR PLATINUM
Present Credit Limit BPI BLUE MASTERCARD BPI GOLD MASTERCARD (at least 75k)
Requested Credit Limit PETRON-BPI MASTERCARD BPI AMORE VISA PLATINUM (at least 150k)
BPI EDGE MASTERCARD BPI PLATINUM REWARDS MASTERCARD (at least 150k)
Dispute Card Transactions BPI E-CREDIT BPI VISA SIGNATURE (at least 300k)
BPI AMORE VISA
Please refer to the specified Dispute Forms (Form 1 or Form 2) via DTAS
Card Conversion (OLD CARD)
Reversal of Fees Existing Card Type
Card Number
Reason
CARD TYPE REQUESTED:
Date of Statement of Accounts REGULAR PLATINUM
Total Amount BPI BLUE MASTERCARD BPI GOLD MASTERCARD (at least 75k)
Breakdown: PETRON-BPI MASTERCARD BPI AMORE VISA PLATINUM (at least 150k)
Annual Fee BPI EDGE MASTERCARD BPI PLATINUM REWARDS MASTERCARD (at least 150k)
Finance Charge BPI E-CREDIT BPI VISA SIGNATURE (at least 300k)
Penalty BPI AMORE VISA

Other Fees (Please indicate)

Replacement (with Php 400 replacement fee)
Card Number
Refund of Overpayment
Reason for Replacement
Reason
Last Payment Details:
Card Cancellation
Date of Payment
Amount
Reason:
Payment Channel Branch Express Online Others (please specify)
ALL PRIMARY AND LINK CARDS under this customer number
Change in Cardholder’s Information
Selected credit card number/s listed below:
Status / Name:
____ w/ card replacement (with Php 400 replacement fee) Cardholder Name Credit Card Number
____ w/o card replacement
Please attach the required documents (Photocopy):
____ MARRIAGE CONTRACT
____ ANNULMENT PAPERS
____ VALID ID, for change in name only if card tenure is more than 1 year. Express Start Cancellation
Preferred billing address REQUEST TYPE (Please check the appropriate box)
Residence Office Full Release of Holdout with Card Retention
From: Full Release of Holdout with Card Retention and ICL
(House/Unit No., Floor, Building Name)
To: Partial Release of Holdout with Card Retention
(Street Name, Village, Barangay)
Full Release of Holdout and Card Cancellation

(Municipality, City, Province) (Zip Code)

If existing cardholder with other bank/s:
Credit Card Company: Credit Card Number:

Telephone number
Residence Office
From:
HOLD-OUT ACCOUNT(S) (List all active accounts in full hold. CHECK box if for release)
To:
Acct 1 Type & Number Hold-out Amount
Mobile Number Acct 2 Type & Number Hold-out Amount
From:
To: Acct 3 Type & Number Hold-out Amount
6 3 9
E-mail address Statement of Account Enrollment Type
From:
To: eStatement Paper Statement of Account EOL Viewing only

Card Number:
Cut-off / billing cycle
From:
To:
For Branch Use only:
NOTE: This is for documentation purposes only. All requests must be sent via DTAS.
Client’s Signature over Printed Name: Verified by: Processed by:

As of January 2022
 NATURE / TYPE OF EMPLOYMENT / BUSINESS / PROFESSION
ACT - Accounting / Bookkeeping / Tax Practice / Services LAW - Lawyer
ADS - Advertising / Marketing / Sales Activities LEG - Legal Practice
AGR - Agriculture / Hunting / Forestry / Animal Farming / Fishing LSE - Leasing / Rental Activities (e.g., land, building, machinery, etc.)
ARC - Architect MED - Medical Service (includes caregiving)
BHS - Beauty and Health services (e.g., spa, beauty parlors, fitness centers) MFG - Manufacturing (Non-Food, e.g., garments, vehicles, jewelry, heavy equipment, etc.)
BNK - Banking MIL - Military-NP
BPO - Business Process Outsourcing (e.g., Call Centers, Billing / Credit / Collections, etc.) MIN - Mining
BRO - Brokerage MNF - Manning or Employment Agencies – Foreign
CHA - Charities MNL - Manning or Employment Agencies – Local
CMT - Commodities Trader NGO - Foundation (NGO)
COM - Communication (Telecommunications includes postal) OPS - Other Professional Services (e.g, Delivery, Photography, Catering, Interior Design, Fashion Design Styling, etc.)
CSY - Consultancy (e.g., computer-related consultancy-hardware / software, technical engineering / architectural, scientific-related PUB - Publishing / Printing / Reproduction of Recorded Media
consultation, business consultation) PWN - Pawnshop
CTN - Construction (e.g., building, plumbing, electrical, carpentry) RCY - Recycling
DOC - Doctor / Dentist REL - Real Estate (e.g., development, sales, etc.)
EDU - Education (including private tutorials, special education) REM - Remittance Agent
EMB - Embassies / Foreign Consulates REO - Religious Organization
ENG - Engineer REP - Repairs Services (e.g., machinery, automobiles, television, cellphone, etc.)
ENT - Entertainment (Recreational / Cultural / Sporting Services (e.g., party planning services, event organizing, carnival SAN - Sanitation / Cleaning / Housekeeping Services (e.g., janitorial services, building maintenance, laundry, etc.)
rides rental, fireworks displays, media network, film productions, etc.)) SHP - Maritime or Shipping
FDI - Food Industry / Food Manufacturing / Food Preparation / Processing / Food Packaging TOU - Tourism (e.g., Hotels, Inns, Resorts, Tour agencies, Restaurants)
FIN - Financial Services TRA - Wholesale / Retail Trade
FXD - FX Dealer / Money Changer TRN - Transport (Air, Water, Land)
GAC - Gaming Clubs / Casino UTI - Utilities (Electricity, Gas & Water Supply)
GOV - Government Service-NP WAT - Collection, Purification & Distribution of Water
INS - Insurance Activities OTH - OTHERS

Branch Annual Membership Fee Reversal Request Form

AMF Reversal Request Form

This is to request for the annual membership waiver of: January 2022

Principal Cardholder's Name:

Card number/s to be requested for reversal:

□ Principal □ Supplementary

□ Principal □ Supplementary

Please indicate if card is principal orsupplementary □ Principal □ Supplementary

□ Principal □ Supplementary

□ Principal □ Supplementary

Date of Request:

Please be reminded that the waiver of annual membership fee is subject for approval and reversal is not guaranteed upon request. For now, kindly settle your current statement balance including the Annual
Membership Fee to avoid unnecessary charges.

□ This is to acknowledge that the Branch personnel has discussed with me the details needed to process the reversal of my annual membership fee.

Requested by:

___________________________
Cardholder’s printed name and signature

______________________________________________________
To be accomplished by the Branch:

□ □
Requirement to be fulfilled:
None Spend Condition

□ EOL Activation & Paper SOA Suppression

□ Exception Handling

□ Supplementary Card

Please remind clients to settle their outstanding balance including the Annual Membership Fee to avoid unnecessary charges while waiting for the status of their request.

□ This is to acknowledge that I have discuss ed the requirements needed to process the client’s reversal and he/she has agreed to do the requirement checked above.

Endorsed by:

____________________________
Branch Personnel’s printed name and signature