Truth in Lending Act
		Application Center

Important: Application forms received without requirements will not be processed. Your home or business address must be in Metro Manila, Laguna, Cavite, Rizal, Bulacan, Pampanga, Metro Cebu, Davao City or residing within a 30km. radius of a BPI or BPI Family Bank Provincial Business Center.

	Choose the BPI Express Credit card that suits your lifestyle!

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Type of Application

BPI Express Credit Classic BPI Express Credit Blue MasterCard BPI Express Credit Gold MasterCard BPI WorldPerks® MasterCard Petron-BPI MasterCard BPI Edge MasterCard

	Fill out the Application Form so you could enjoy great perks and privileges!

ABOUT ME

If you are an existing WorldPerks member, please provide your name as it appears on your WorldPerks card or e-statement

	* Last Name
	* First Name
	* Middle Name

	If you are an existing WorldPerks member, please provide your WorldPerks membership number. If you are not a WorldPerks member, please leave this blank
	Worldperks Membership Number
	* Mother's Full Maiden Name
	* Birthdate	- Month - January February March April May June July August September October November December - Day - 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , - Year - 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
	Sex	- Sex - Male Female
	Civil Status	- Civil Status - Single Married Separated Widow(er)
	No. of Dependents	- Please Choose - 0 1 2 3 4 5 6 7 8 9 10
	T.I.N. (Tax Identification Number)	- - -
	SSS Number
	Car Ownership	- Car Ownership - Owned Mortgaged
	If mortgaged	Php  per month
	No. of cars owned
	Citizenship	- Citizenship - Filipino Non-Filipino
	Preferred Billing Address (where correspondences will be sent)	- Billing Add - Residence Office
	* Residence Address
	Zip Code
	Home Ownership	- Home Ownership - Owned Living with Relatives Mortgaged Rented
	If Mortgaged or Rented	PhP  per month
	Years of Stay	- Years of Stay - 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0 10.5 11.0 11.5 12.0 12.5 13.5 14.0 14.5 15.0 15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0 23.5 24.0 24.5 25.0 25.5 26.0 26.5 27.0 27.5 28.0 28.5 29.0 29.5 30.0 30.5 31.0 31.5 32.0 32.5 33.0 33.5 34.0 34.5 35.0 35.5 36.0 36.5 37.0 37.5 38.0 38.5 39.0 39.5 40.0 40.5 41.0 41.5 42.0 42.5 43.0 43.5 44.0 44.5 45.0 45.5 46.0 47.0 47.5 48.0 48.5 49.0 49.5 50.0
	* Home Phone Number
	Fax Number
	Mobile Number
	Send me SMS/MMS promo updates	- Please Choose - Yes No
	E-mail Address
	ABOUT MY SPOUSE
	Last Name
	First Name
	Middle Name
	Employer/Business Name
	Position
	Years w/ Present Employer/Business	- Years In Business - 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0 10.5 11.0 11.5 12.0 12.5 13.5 14.0 14.5 15.0 15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0 23.5 24.0 24.5 25.0 25.5 26.0 26.5 27.0 27.5 28.0 28.5 29.0 29.5 30.0 30.5 31.0 31.5 32.0 32.5 33.0 33.5 34.0 34.5 35.0 35.5 36.0 36.5 37.0 37.5 38.0 38.5 39.0 39.5 40.0 40.5 41.0 41.5 42.0 42.5 43.0 43.5 44.0 44.5 45.0 45.5 46.0 47.0 47.5 48.0 48.5 49.0 49.5 50.0
	Office/Business Address
	Zip Code
	Office/Business Phone Number
	Gross Annual Income	Php
	Birthdate	- Month - January February March April May June July August September October November December - Day - 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , - Year - 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
	T.I.N. (Tax Identification Number)	- - -
	ABOUT MY WORK FINANCES
	Employment Type	- Please Select - Employed Self-Employed Retired OFW Others
	Others
	Years w/ Present Employer/Business	- Years In Business - 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0 10.5 11.0 11.5 12.0 12.5 13.5 14.0 14.5 15.0 15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0 23.5 24.0 24.5 25.0 25.5 26.0 26.5 27.0 27.5 28.0 28.5 29.0 29.5 30.0 30.5 31.0 31.5 32.0 32.5 33.0 33.5 34.0 34.5 35.0 35.5 36.0 36.5 37.0 37.5 38.0 38.5 39.0 39.5 40.0 40.5 41.0 41.5 42.0 42.5 43.0 43.5 44.0 44.5 45.0 45.5 46.0 47.0 47.5 48.0 48.5 49.0 49.5 50.0
	Employer/Business Name
	Position
	Nature of Business/Industry
	Office/Business Address
	Zip Code
	Office/Business Phone Number
	Local/Ext Number
	Fax Number
	E-mail Address
	Gross Annual Income	Php
	Previous Employer
	Years w/ Previous Employer/Business	- Please Select - 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0 10.5 11.0 11.5 12.0 12.5 13.5 14.0 14.5 15.0 15.5 16.0 16.5 17.0 17.5 18.0 18.5 19.0 19.5 20.0 20.5 21.0 21.5 22.0 22.5 23.0 23.5 24.0 24.5 25.0 25.5 26.0 26.5 27.0 27.5 28.0 28.5 29.0 29.5 30.0 30.5 31.0 31.5 32.0 32.5 33.0 33.5 34.0 34.5 35.0 35.5 36.0 36.5 37.0 37.5 38.0 38.5 39.0 39.5 40.0 40.5 41.0 41.5 42.0 42.5 43.0 43.5 44.0 44.5 45.0 45.5 46.0 47.0 47.5 48.0 48.5 49.0 49.5 50.0
	MY OTHER CREDIT CARDS

Credit Card Company	Card Number	Credit Limit	Expiry Date(Month/Year)

	MY BPI/BPI FAMILY BANK ACCOUNTS

Account/Loan Number	Deposit/Loan Type	Branch Location

	MY OTHER CREDITORS

	Creditor
	Date Granted (MM/DD/YY)	N/A January February March April May June July August September October November December N/A 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , N/A 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
	Term
	Amount Granted	Php
	Monthly Amortization	Php per month
	Creditor
	Date Granted (MM/DD/YY)	N/A January February March April May June July August September October November December N/A 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , N/A 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
	Term
	Amount Granted	Php
	Monthly Amortization	Php per month
	Creditor
	Date Granted (MM/DD/YY)	N/A January February March April May June July August September October November December N/A 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , N/A 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
	Term
	Amount Granted	Php
	Monthly Amortization	Php per month

	1st supplementary waived for life!

If you are an existing WorldPerks member, please provide your name as it appears on your WorldPerks card or e-statement

	1. Last Name
	First Name
	Middle Name

If you are an existing WorldPerks member, please provide your WorldPerks membership number. If you are not a WorldPerks member, please leave this blank

	Worldperks Membership Number
	Birthdate
	Sex	- Sex - Male Female
	Relationship

	If you are an existing WorldPerks member, please provide your name as it appears on your WorldPerks card or e-statement

	2. Last Name
	First Name
	Middle Name

If you are an existing WorldPerks member, please provide your WorldPerks membership number. If you are not a WorldPerks member, please leave this blank

	Worldperks Membership Number
	Birthdate
	Sex	- Sex - Male Female
	Relationship
	MY PERSONAL REFERENCES

Name (Last/First/Middle)	Residence/Employment Address	Employer/Business Name	Employer/Business Phone Nos.

DECLARATION

I certify that the information given by me is true and correct and that any material misrepresentation or falsity therein shall be construed as an act to defraud BPI for which civil and/or criminal liability can be pursued against me. I hereby authorize BPI to: (i) inquire about and investigate all the declared information from whatever sources BPI may consider appropriate; (ii) use any contact details to communicate to me for whatever purpose; (iii) disclose any information herein provided to any person or entity. For this purpose, I agree to indemnify and hold BPI free and harmless from any and all claims, liabilities, damages, suits or causes of action of whatever nature, now or hereafter arising from or in connection with the foregoing authorization. Further, I agree that: (i) the application from and the related documents submitted to BPI shall not be returned to me for whatever reason; (ii) in case of disapproval of my application, BPI is under no obligation to provide me with the reason for such decision; and (iii) BPI reserves the right to restrict the use of and/or terminate/cancel the card without need of prior notice from BPI, if it is later determined that the information certified by me is false. In the event that my application is approved, my use of the credit card shall be deemed my acceptance/agreement with the terms and conditions governing the issuance and the use of the BPI Express Credit Card as printed at the back of the card carrier which I will receive together with my credit card. I accept liability for all changes to the principal card and supplementary cards. Any alterations, amendments, exceptions, reservations or scrubblings made by me herein, in the BPI Express Credit Card terms and conditions, as well as in the provisions contained in the Statement of Account(SOA), Installment Plan contract, Charge Slip, other card documents, Suretyship Agreement and/or such otherrelated instruments or documents, not approved in accordance with BPI's appropriate procedures, shall not bevalid and binding. Please wait for the application confirmation page to appear to confirm that your application has been received.