1.

MABUHAY MILES MEMBERSHIP

Provide your Mabuhay Miles membership number in order to enjoy conversion of rewards points earned to Mabuhay Miles. A new Mabuhay Miles membership number will be auto generated if the Mabuhay Miles
membership number portion below is left blank or an invalid number is provided. No adjustment can be made afterwards.
Are you a current member of Mabuhay Miles Club?

Yes

If you are, please indicate your existing Mabuhay Miles membership number

No

2. PERSONAL INFORMATION
First Name

Middle Name

Date of Birth

Sex

mm

dd

Status

Citizenship

SSS / GSIS

yyyy

Filipino

Female

Male

No. of dependents:

Mothers Full Maiden Name

Last Name

Home Address ( Number, Street, District )

Non Filipino

Single

Separated

Married

Widow

TIN

Mobile Number

Home Landline Number

ZIP Code

City / Provinces

Years of Stay

If you are a foreign national, you must also submit a photocopy of one of the following:
Valid Passport with Resident Visa
Special Investors Resident Visa
I.D. No.
Passport No.
Work Permit and Valid Visa
ACR / ICR or I-Card
I.D. No.
I.D. No.
Expiry

0 9

Email

Current Relationship with Allied Bank:

Yes

No

ABC Account Number: ________________________________________________________________

YOUR OTHER CREDIT CARDS (at least one year principal ownership)
Credit Card Company

Card Number

Credit Limit

3. WORK AND FINANCES

Business / Company Phone Numbers

Business / Company Name

Business / Company Address (Number, Street, District)

ZIP Code

City / Provinces

Employment Status
Employed

Rank

Position / Occupation

Year/s with the Company

Annual Income

Sales/Commission earner

Self-employed

Retired/Unemployed Source of Income ____________________

OFW

4. SPOUSE INFORMATION
First Name

Middle Name

mm

Business / Company Address (Number, Street, District, City/Province)

Office Tel. No.

Employment Status
Employed
Self-employed
Unemployed

Citizenship

Date of Birth

Last Name

dd

yyyy

Filipino
Non Filipino

Tenure with Present Emplyer or Business

________ Year/s ________ Month/s

Mobile Number

0 9

5. BILLING INFORMATION
Billing Address:

Home

(Card will automatically be delivered to billing address)

Office

6. SUPPLEMENTARY CARD

(must be at least 13 years old)

Middle Name

First Name

Last Name

Date of Birth
mm

dd

* Sub Limits

Mothers Full Maiden Name

yyyy

Sex
Male

Female

Relationship with Principal Applicant

Mobile Number

Email Address

0 9

Signature

*For Sub Limit: Specify amount rounded off to the nearest thousand. If not specified, default sublimit is 100%.

7. LIPAT NA, LIPAD PA! BALANCE TRANSFER (PROMO RATES). Promo is until April 15, 2012.
Now, you can easy balance transfer to Mabuhay Miles MasterCard with a low transfer rate of 0.33% for 24 months, or opt to get free flights!
Payment Terms:
Option A

Option B (with Bonus Points for New-to-Bank Only)

12 Months
18 Months
24 Months

18 Months
24 Months

Card Company: __________________________________________________________________

Cardholders Name: _______________________________________________________________
Credit Card No.: __________________________________________________________________
Card Expiry Date: _________________________________________________________________
Amount to be transferred: Php _______________________________________________________

8. DECLARATION
By signing below, I/We are applying for an Allied Bank Credit Card. I/We understand that the Allied Bank Credit Card is issued by Allied Banking Corporation (Allied Bank). I/We agree to abide by and be governed by the Terms & Conditions governing
the issuance and use of the Allied BankCredit Card and all future amendments thereto. I/We authorize Allied Bank to verify the information in this application and to receive and exchange information about me/us, including requesting reports from
consumer credit reporting or reference schemes. I/We also authorize Allied Bank and its affiliates to contact these sources for information from this application and from consumer credit reports for marketing and administrative purposes and to
share such information with each other.
I/We hereby agree to waive my/our right/s regarding the confidentiality of deposits under R.A. 1405, as amended, as the disclosure is necessary and relevant in the evaluation of my/our application for an Allied Bank Credit Card and to ensure a
succesful debit under an auto-debit arrangement with my/our ABC deposit account should I/We decide to avail of the auto debit payment facility for my/our Allied Bank Credit Card. I/We hereby authorize Allied Bank, in the event that my account
becomes past due, to offset against my ABC deposits, any unpaid balances, and subsequently cancel my card. I/We further authorize and consent Allied Bank to be the recipient of these information and to conduct random verification with the
BIR in order to establish authenticity of the Income Tax Return (ITR).
I/We hold ourselves, jointly and severally liable for all obligations and liabilities incurred with the use of the Allied Bank Credit Card and supplementary cards and, in event that my/our application for an Allied Bank Credit Card is disapproved, Allied
Bank is under no obligation to provide me/us with the reason for such a decision.
The accomplished application form and requirement/s submitted, become property of Allied Bank. Allied Bank is under no obligation to return the said documents.
Sub-limit Declaration: Sub-limit is expressed in Peso currency. International transactions are authorized based on the available limit. However, international transactions are posted and billed on the Dollar account.

Please refer to the booklet of Terms and Conditions for more details.

Source Tag

Program Name/Code:

FOR BANK USE ONLY

Employee Number:
Employee/

Signature of Principal Applicant

Date

Branch/Channel Code:

Solicitors Printed Name: