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    Landbank Cash Card/Prepaid Card Enrollment Form: Fernando JR Labides Viscara

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    Fernando Viscara Jr.
    1) Fernando Jr Labides Viscara enrolled for a Landbank cash card/prepaid card. 2) He provided his personal details such as name, address, contact number, date of birth, profession and source of income. 3) The document is an enrollment form for Landbank's cash card/prepaid card where the purchaser provides necessary know-your-customer information for verification and activation of the card.

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    Landbank Cash Card/Prepaid Card Enrollment Form: Fernando JR Labides Viscara

    Uploaded by

    Fernando Viscara Jr.
    51 views2 pages
    1) Fernando Jr Labides Viscara enrolled for a Landbank cash card/prepaid card. 2) He provided his personal details such as name, address, contact number, date of birth, profession and source of income. 3) The document is an enrollment form for Landbank's cash card/prepaid card where the purchaser provides necessary know-your-customer information for verification and activation of the card.

    Original Title

    TES-02-07-07151-2019-10861

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    1) Fernando Jr Labides Viscara enrolled for a Landbank cash card/prepaid card. 2) He provided his personal details such as name, address, contact number, date of birth, profession and source of income. 3) The document is an enrollment form for Landbank's cash card/prepaid card where the purchaser provides necessary know-your-customer information for verification and activation of the card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views2 pages

    Landbank Cash Card/Prepaid Card Enrollment Form: Fernando JR Labides Viscara

    Uploaded by

    Fernando Viscara Jr.
    1) Fernando Jr Labides Viscara enrolled for a Landbank cash card/prepaid card. 2) He provided his personal details such as name, address, contact number, date of birth, profession and source of income. 3) The document is an enrollment form for Landbank's cash card/prepaid card where the purchaser provides necessary know-your-customer information for verification and activation of the card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    LANDBANK OF THE PHILIPPINES

    Exhibit 2
    Branch LAPU-LAPU

    LANDBANK CASH CARD/PREPAID CARD ENROLLMENT FORM


    Date: Mar 14, 2021
    Please check the type of card being enrolled:

    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

    Type of ID Presented: ID Number Presented: Profession: TIN: Source of Fund:


    Student ID 20190521 Student 340239598000 Other - Stipend

    Name of Employer/Company/Business/School: Contact Number/s: Email Address: Gross Salary:


    CORDOVA PUBLIC COLLEGE 9157264555 fernandoviscara1998@gmail.com P30,000 and below

    Cardholder's Information
    Cardholder's Name: Contact Number/s: Date of Birth:
    FERNANDO JR LABIDES VISCARA 9157264555 May 29, 1998

    Permanent Address: Zip Code: Relationship with:


    SANTO NINO ST, MATAPAY 6524 the Purchaser
    HILONGOS, LEYTE
    Present Address: Zip Code: N/A
    PUROK 1, SAN MIGUE 6017
    CORDOVA, CEBU
    Name to Appear on the Card (maximum of 22 characters):

    Initial Load Amount of Fee/Charges to be paid:

    (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:

    Signature Over Printed Name Signature Over Printed Name


    of Purchaser/Applicant/Authorized Signatory of Purchaser/Applicant/Authorized Signatory
    FOR BANK'S USE ONLY
    Processed by: Checked by: Approved by:

    Customer Associate/NAC BOO/BSO Branch Head


    Date/Time: ___________________ Date: ___________________ Date: ___________________
    for Branches without BOO
    Validation Print (if paid through cash):

    CASH CARD/PREPAID CARD/PIN MAILER CLAIM STUB


    Card Number: Card Holder's Name: Purchaser's Name: Date:

    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

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