CARDHOLDER REQUEST FORM

24/7 Customer Service Hotline : 818-9-818

Domestic Toll-Free : 1-800-10-818-9-818
Email Address: PNBCreditCards@pnb.com.ph

Please change my PNB Credit Card to: X Please increase my credit limit/s to:

PNB Essentials Mastercard PNB Classic Visa 300,000

Php _____________________ Equivalent
/ US$ ______________________
PNB Platinum Mastercard PNB Gold Visa I understand that my approved aggregate credit limit
shall be applicable to all my PNB Credit Cards,
PNB-PAL Mabuhay Miles PNB-The Travel Club including all its Supplementary Cards. This will still be
Platinum Mastercard Platinum Mastercard subject to credit evaluation.
PNB-PAL Mabuhay Miles World PNB-Jewelmer Joaillerie For dual currency cards, local transactions are billed in Peso while
Mastercard Platinum Mastercard international transactions are billed in US Dollars. There will be
separate monthly statements for Peso and Dollar Billings.
PNB Diamond UnionPay* Others ________________
Note: Please attach income documents - ITR / 2 months latest billing
Single Currency Dual Currency statements of a Non-PNB Credit Card / 1 month latest payslip.
*If no selection is made, default is single currency.
Note: For upgrades, please attach income documents.

Supplementary Card

1. I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I 2. I ___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___I
Last Name Last Name

I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___II___I I___I___I___I___I___I___I___I___I___I___I___I___I___I___I___II___I
First Name M.I. First Name M.I.
Sub-Limit: _______________________________________ Sub-Limit: ____________________________________________
For Sub-limit: Principal cardholder assigns the sub-limit. Specify the amount, rounded off to For Sub-limit: Principal cardholder assigns the sub-limit. Specify the amount, rounded off to
the nearest thousand. If not specified, the default sub-limit is 100%. the nearest thousand. If not specified, the default sub-limit is 100%.

Birthday (mm/dd/yyyy): ___________________________ Birthday (mm/dd/yyyy): ____________________________

Gender: __________ Civil Status: _________________ Gender: __________ Civil Status: _________________
Relationship to Relationship to
Principal Cardholder: _____________________________________ Principal Cardholder: _____________________________________

Mother’s Mother’s
Maiden Name: __________________________________________ Maiden Name : ____________________________________________

_________________________________________________ _________________________________________________
Signature of Supplementary Cardholder Signature of Supplementary Cardholder
I understand that, if issued, the supplementary card will bear a different card number. Nevertheless, in all cases, all
purchases/transactions made through the use of supplementary card will be billed to me. The supplementary cardholder/s has read
and understood the Terms and Conditions set forth in my signed application form and agrees to use his/her supplementary card
accordingly. He/she agrees to be held jointly and severally liable with me for the payment of obligations under the agreement.

Mode of Payment Information Update

Auto Debit a. PNB PNB Savings
Please update the following details:
Arrangement (ADA)* b. Full Amount Minimum Amount
Account to Auto Debit Contact Number/s:
Peso
Account
FOR PESO BILLS ONLY Mobile Number: Principal: ________________________
Dollar
Supplementary: _____________________
Account
FOR DOLLAR BILLS ONLY
Home Tel No.: ___________________________________
Pay to Bank Peso Bills Dollar Bills
Office Tel No.: ___________________________________
If the account number does not belong to the principal cardholder, kindly attach an
authorization letter signed by the depositor and signature verified by branch officer/
personnel. Request for ADA will apply to the indicated/specified card number only.
If account is under a company/corporation, submission of secretary’s certificate or Address:
board resolution is required. If sole proprietorship, DTI/SEC permit is required.
* If selection is not checked, payment will automatically be minimum.
Home Address: ___________________________________
Please replace my card due to:
Office Address: ___________________________________
Correction ** Change of Name **
Preferred Billing Address: Home Office

Damaged Card Others ________________________________________

Others

** Attach a valid ID and supporting documents such as birth certificate, marriage Email Address:
certificate and the like.

Principal: Old: ___________________________________

First Name ________________________________________
New: __________________________________
Middle Name ______________________________________
Supplementary: Old: ______________________________
Last Name _________________________________________
New: ______________________________

NAME OF PRINCIPAL CARDHOLDER 5437619001201036

CARD NUMBER PRINCIPAL CARDHOLDER’S SIGNATURE
5240466560504013
Joseph Jahred Angelo Torres Sunga 4889079110271493
MOBILE NUMBER MABUHAY MILES NUMBER DATE
Primary - 09178390939 Note: If request was coursed through the branch, branch officer/
Secondary - 09188390939 / 09228390939 May 01 2019 personnel should signature verify.

PNB is regulated by the Bangko Sentral ng Pilipinas. CHRF - MAR2017

BSP contact details: (02) 708-7087 / consumeraffairs@bsp.gov.ph