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
[email protected] 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
