EASTWEST CREDIT CARD APPLICATION FORM

To apply, submit completely filled-out Credit Card Application Form & documentary requirements via e-mail to [email protected].
MY EASTWEST CREDIT CARD OF CHOICE (Please choose one) □ EastWest Platinum Mastercard □ EastWest Dolce Vita Titanium Mastercard □ EastWest Classic Mastercard □ Hyundai Mastercard
Depending on EastWest’s evaluation, you may receive a card type other than your □ EastWest Visa Platinum □ EastWest Gold Mastercard □ EastWest Visa Classic □ Other Cards
choice. □ EastWest EveryDay Titanium Mastercard □ EastWest Visa Gold □ EastWest Practical Mastercard ________________
EASTWEST CREDIT CARD NUMBER
ARE YOU AN
Yes □ Depositor No □ ARE YOU AN EXISTING PRINCIPAL
EXISTING
EASTWEST CLIENT?
□ Borrower EASTWEST CREDIT CARDHOLDER? Yes □ No □ X X X X X X

MY PERSONAL INFORMATION
FULL NAME (First, Middle, Last) Name to Appear on Card
(Must not exceed 19 characters
including spaces)
CITIZENSHIP/NATIONALITY CIVIL STATUS NO. OF DEPENDENTS NO. OF CARS EDUCATION
□ Filipino □
Others __________________ ACR No. ___________ □ Single □
Married □ Widowed □ Separated OWNED □ High School □ College □ Some College □ Post Graduate
BIRTHDATE (Month/Day/Year) PLACE OF BIRTH GENDER MOTHER’S FULL MAIDEN NAME (First, Middle, Last) TAX IDENTIFICATION NUMBER (TIN) SSS/GSIS NUMBER
(City, Town, Province and Country)
□ Male ANT ANT ANT
□ Female IMP
ORT
IMP
ORT
IMP
ORT

MOBILE PHONE NUMBER HOME PHONE NUMBER PRIMARY E -MAIL ADDRESS ALTERNATE E-MAIL ADDRESS
Your mobile number will be used for sending of cardholder notices, (If provincial, include area code) Your e-mail address will be used for sending of your EastWest Credit Card
marketing promos, your one-time-password, security alerts, etc. electronic Statement of Account, cardholder notices, marketing promos, security
ANT
alerts, online banking, etc.
ORT
IMP

PRESENT/HOME ADDRESS (No./Street/Village/Barangay/Municipality/City/Province/ZIP Code) HOME OWNERSHIP YEARS

□ Owned, Mortgaged □ Owned, Not Mortgaged OF STAY
□ Living with Parents/Relatives □ Rented
PERMANENT ADDRESS (No./Street/Village/Barangay/Municipality/City/Province/ ZIP Code) □ Please check if same as Present/Home Address

Kindly indicate if you are related to an EastWest Director, NAME RELATIONSHIP

Officer or Stockholder (DOSRI)
MY WORK AND FINANCES
SOURCE OF FUNDS EMPLOYMENT POSITION/RANK JOB TITLE/OCCUPATION
□ Salary/Benefits □ Remittance □ Private □ Retired □
Clerk □
Executive (AVP & up)
□ Allowances □ Retirement/Separation □ Government □ Others □
Officer-Junior/Supervisor □
Self-Employed/Proprietor ORT
ANT
□ Business Income □ Others______________ □ Self-Employed ___________________ □
Officer-Senior/Manager Others □ IMP

COMPANY/BUSINESS NAME NATURE OF PRESENT BUSINESS □ Utilities

□
Agricultural/Mining □
Community/Social/Personal □ Insurance □ Wholesale/Retail
□
Banking Construction □ □ Manufacturing □ Others ________
DEPARTMENT NO. OF YEARS WITH PRESENT □
BPO Financing □ □ Real Estate
EMPLOYER/BUSINESS □
Business/Commercial Services Government □ □ Transportation/Communication
COMPANY/BUSINESS ADDRESS (Floor/Bldg./No./Street/Village/Barangay/Municipality/City/Province/ZIP Code)

COMPANY/BUSINESS PHONE NUMBER (Include local/extension

T
and if provincial, include area code) GROSS ANNUAL INCOME (Should match income document submitted)
AN
ORT
IMP

MY CREDIT CARD REFERENCES (Please indicate all major principal credit cards you own. Must be active and at least 1 year.) Noting your credit card references will expedite processing of your application.
CARD ISSUER CARD NUMBER MEMBER SINCE CREDIT LIMIT

ANT ANT ANT

ORT ORT ORT
IMP IMP IMP

MY SPOUSE’S INFORMATION
NAME OF SPOUSE (First, Middle, Last) COMPANY/BUSINESS ADDRESS
(Floor/Bldg./No./Street/Village/Barangay/Municipality/City/Province/ZIP Code)

COMPANY/BUSINESS NAME COMPANY/BUSINESS PHONE NUMBER MOBILE PHONE NUMBER GROSS ANNUAL INCOME

MY PERSONAL/TRADE
MY PERSONAL/ REFERENCE
FULL NAME (First, Middle, Last) COMPANY/BUSINESS NAME CONTACT NUMBER

MY BILLING PREFERENCE MY STATEMENT OF ACCOUNT

Send my Card to my: Go green, Go paperless! In support of the global effort to save Mother Earth, your credit card Statement of Account (SOA) will
be sent to your e-mail address on record through our electronic Statement of Account (e-SOA) Facility. It’s convenient, secure
□ Present/Home Address □
Company/Business Address
and earth-friendly. Your e-SOA will be sent to your primary e-mail address in a password protected PDF file. With an e-SOA, you
can view your SOA anytime and keep the file without the paper clutter. An SMS advisory will be sent to your mobile number on
Your Card, Statement of Account (SOA) and other communications may be record to let you know that your SOA has been sent.
delivered to the alternative address if we are not able to deliver to your preferred Should you prefer to receive your SOA in your billing address, please tick this box:
address. □
Send my SOA to my billing address
AGREEMENT
I hereby certify that all information and documents given in this application are complete, true and correct and that my signature/s herein is/are genuine.
Disclosure and Sharing of Information
a. Processing of application
I hereby consent and authorize EastWest, any of its offices, branches, subsidiaries, affiliates, agents, representatives and third parties, to conduct random verification with the BIR, any other appropriate government agency or third party including banks and
financial institutions to establish the authenticity of the information I declared and the documents I submitted in relation to my application as it may be necessary for the processing and evaluation of my application and I hereby waive any rights on the
confidentiality of my income information as required by BSP Circular 622, as amended by BSP Circular 855. I further consent and authorize the disclosure of information pursuant to Republic Act No. 10173 or the Data Privacy Act of 2012, its Implementing
Rules and Regulations, and other rules and regulations relating to data privacy.
b. Account Maintenance and Servicing
I hereby authorize the transfer, disclosure and communication of EastWest of any information relating to my account/s with EastWest as well as all of the documents submitted for this application to any of its offices, branches, subsidiaries, affiliates, agents,
representatives and third parties for application processing, data processing/storage, customer satisfaction surveys, and for any other purpose as EastWest may deem appropriate, and as may be required by law or regulation. I hereby also authorize the regular
submission and disclosure to any and all credit information service providers, such as, but not limited to, Credit Card Association of the Philippines, Credit Information Corporation, BSP, Anti-Money Laundering Council, Banker's Association of the Philippines, of
any information, whether positive or negative, relating to my basic credit data (as defined under R.A. No. 9510) with EastWest, as well as any update or correction thereof. The foregoing constitutes my written consent for any such submission and disclosure
of information relating to my account/s for the purpose indicated above and under applicable laws, rules and regulations.
I agree to hold EastWest free and harmless from any and all liabilities that may arise from any transfer, disclosure or storage of information relating to my account/s.
c. Marketing and Sales Offers
I hereby authorize the transfer, disclosure and communication of EastWest of any information relating to my account/s with EastWest as well as all of the documents submitted for this application to any of its offices, branches, subsidiaries, affiliates, agents,
representatives and third parties for product and service offers to be made to me through mail/e-mail/fax/SMS, telephone or through other forms of media, and for any other purpose as EastWest may deem appropriate, unless I expressly notify EastWest
otherwise through the following contact information:
Customer Service: (02) 888-1700 E-mail: [email protected]
I understand that this application is subject to EastWest's credit policies and procedures. I understand and agree that should my credit card application be approved, my card may be delivered activated subject to EastWest’s activation policy and guidelines. In
case of disapproval of my application, I understand that EastWest is under no obligation to disclose the reason/s for such disapproval unless required by law or regulation. The accomplished application form and requirement/s I submitted become the property
of EastWest and EastWest is under no obligation to return the said documents to me regardless of the outcome of the application.
By signing below, I agree to abide by the Terms and Conditions Governing the Issuance and Use of EastWest Credit Cards as found in the Bank’s website. I also agree to be bound by any and all amendments thereto as well as all laws, rules, regulations and
official issuances applicable to EastWest which may hereinafter be issued, as well as such other terms and conditions governing the use of other facilities, benefits, products or services which shall be made available to me. I also agree that EastWest may change
any of the provisions in its Terms and Conditions and the fees and charges for its products and/or services from time to time and I agree to be notified of such changes through notice sent to me through any of the following means, at the discretion of EastWest
unless I request otherwise: (i) mailed and/or e-mailed notices (sent to my mailing or e-mail addresses indicated in EastWest’s records), (ii) notices posted at EastWest’s branches or (iii) notices in its website.
d. Card Delivery
I authorize EastWest or EastWest’s official courier to deliver the Card to me, to any member of my household, to any of my officemate/co-employee or to any other person that I may authorize through an authorization letter, subject to the existing delivery
policy of EastWest. I agree to hold EastWest free and harmless from any claim, loss or liability, whatsoever arising from the delivery of the Card to my authorized representative.
PRINCIPAL APPLICANT’S SIGNATURE




Signature Over Printed Name Date

By signing in this section, I agree that this Application Form may also serve as my application for other products of EastWest, such as, but not limited to home loan, auto loan, personal loan, EEL, among others, as I may subsequently request from EastWest
or if I am deemed qualified by EastWest. I undertake to submit additional documents as may be required by EastWest for the processing of my application. I understand that the issuance of additional product/s of EastWest shall be subject to credit evaluation
and the approval shall be subject to the discretion of EastWest and that the availment of additional products is my option. I understand that EastWest can rely on the authority/ies given under this section unless I explicitly revoke the same.
PRINCIPAL APPLICANT’S SIGNATURE




Signature Over Printed Name Date

FOR BANK USE ONLY

SOURCE CODE □ MCSC100000000000 □ MCSC200000000000 EastWest is regulated by the Bangko Sentral ng Pilipinas. For inquiries or complaints, you may call
BL/WL/AMLB60 DUP EVALUATION EastWest's 24-Hour Customer Service at (02) 888-1700 or e-mail [email protected].
AML
RATING Similarly, you may contact the BSP Financial Consumer Protection Department at (02) 708-7087.
□ NR
NFIS PHX
□ HR Updated as of November 2017