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Landbank Cash Card/Prepaid Card Enrollment Form: Fernando JR Labides Viscara
Landbank Cash Card/Prepaid Card Enrollment Form: Fernando JR Labides Viscara
Exhibit 2
Branch LAPU-LAPU
Purchaser's Information
Purchaser's Name: With existing account with LBP
FERNANDO JR LABIDES VISCARA if yes, pls specify Acct. No/s:
Cash Card Number/s:
ADDITIONAL INFORMATION FOR WALK-IN INDIVIDUAL PURCHASER, AND CARDHOLDER OF INSTITUTIONAL PURCHASER:
Cardholder's Name: Gender:
FERNANDO JR LABIDES VISCARA Male
Marital Status:
Single
Permanent Address: Zip Code:
SANTO NINO ST, MATAPAY, 6524
HILONGOS, LEYTE
Present Address: Zip Code:
PUROK 1, SAN MIGUE, 6017
CORDOVA, CEBU
Place of Birth: Date of Birth: Nationality: Mother's Maiden Name:
Hilongos,Leyte May 29, 1998 PH LUISA LABIDES VISCARA
Cardholder's Information
Cardholder's Name: Contact Number/s: Date of Birth:
FERNANDO JR LABIDES VISCARA 9157264555 May 29, 1998
(for Prepaid Travel Card) (for Cash Card/Regular Prepaid) (Initial Cost of the Card)
I/We hereby certify that the above information is true and correct:
Prepaid Card Released by: PIN Haller Released by: Approved for Release: Card/PIN Mailer Recieved by:
Card Custodian PIN Mailer Custodian Branch Head/BOO/BSO Signature Over Printed Name
of Purchaser/Cardholder
Date/Time: ___________________ Date/Time: ___________________
Reminder/s:
- You may claim your Prepaid Card after 7 banking days for Metro Manila Branches, and 15 banking days for Provincial Branches, and a replacement fee shall be collected
- Unclaimed Prepaid Card/PIN Mailer shall be perforated after 120 calendar days (for CCT)/30 calendar days (regular) from issuance/re-issuance
- Please sign your Prepaid Card immediately
Validation Print (if debted from deposit account):
TES-02-07-07151-2019-10861-FERNANDO JR LABIDES VISCARA