SUPPLEMENTARY CARD APPLICATION

Note: Supplementary Applicants must submit Document Requirements as listed below.

Reminders1. You are entitled to 4 supplementary cards with the Annual Fee waived for the first year.2. Supplementary applicant/s must submit Documentary Requirements as listed.3. Supplementary applicant/s must be at least 15 years old.4. Supplementary applicants can be any of the following: (1) Should be Children/Legal Dependents* of the Primary Applicants,if below 18 years of age

(2) Should be at least 18 years of age if neither a child nor legal dependent of the Primary Applicant.5. Supplementary cardholder/s share the same card type and credit limit as the Primary Cardholder.6. Application forms with incomplete information will not be processed.

* If Primary Applicant is the Legal Guardian of the minor below 18 years of age, proof of guardianship should be submitted together with supplementary application form

Application Requirements (Supplementary Applicant)

Age at least 15 years oldResidence/Office Address: Manila, Quezon City, Pasig, Pasay, Caloocan, Malabon, Marikina, Navotas, Mandaluyong, Muntinlupa, Las Pinas, Paranaque,

San Pedro Laguna, Binan Laguna, Sta. Rosa Laguna, Bacoor Cavite, Imus Cavite, Carmona Cavite, Dasmarinas Cavite, Cainta, Antipolo, Taytay, San Mateo, Valenzuela

Proof of Identity with Complete Name (At least one of the following): Passport*, Driver’s License*, SSS/TIN ID plus NBI/Police Clearance, Voter’s IDFor minor applicants: School ID with Birth Certificate

NOTE: SHOULD BE VALID, SHOULD CONTAIN NATIONALITY AND DATE OF BIRTH and SHOULD BE PHOTO-BEARINGProof of Residence: Utility bills (electricity, mobile or cable TV issued within the last 3 months) MUST BE UNDER THE NAME OF THE APPLICANT

*At least one is required for minor applicants

For more information, please call HSBC’s 24-Hour Customer Service Hotline at (02) 85-800 or our domestic toll-free number 1-800-1-888-8555 for calls outside Metro Manila but within the Philippines.

Source Code: Agent Code:

Primary Cardholder Data (Please write in block letters only)

Name

Last Name First Name Middle Name

Card Number (If available) – – –

Date of Birth D D M M Y Y Y Y Home Phone No.(REQUIRED; area code + no.)

Email Address Mobile Phone No.(IMPORTANT; mobile code + no.)

Supplementary Card Applicant

Name

Last Name First Name Middle Name

Other Name(aliases or name in another language e.g. Chinese name if any)

Former Name(does not include maiden name)

Name to appear on Card(should only consist of 19 characters including spaces)

Relationship to Primary CardholderCan be any of the following: (1) relatives of the primary applicant defined as spouse, children, children-in-law, parents, parents-in-law, siblings and siblings-in-law who should be at least 15 years old; or (2) non-relatives who should be at least 18 years old.

Date of Birth D D M M Y Y Y Y Gender

Male Female

Place of Birth

(City and Country)

Nationality Mother’s complete maiden name

SSS/GSIS No. Tax Identification Number

Reference Number RBWM_December2016_GPS1570

Type of ID submitted and number (if not SSS/TIN ID)

Driver’s License Passport Others

Current Home Address

House/Lot #, Street Subdivision/District Municipality/City

Province Postal/Zip Code Length of stay (months & years)

Permanent Home Address (If different from home address and/or permanent home address outside of the Philippines for non-resident foreigners and OFWs) House/Lot #, Street Subdivision/District Municipality/City

Province Postal/Zip Code Length of stay (months & years)

Previous Home Address (If length of stay in current address is less than three (3) years) House/Lot #, Street Subdivision/District Municipality/City

Province Postal/Zip Code Length of stay (months & years)

Employer/Business Name

Employer/Business Address

Employment Status Employed Self-employed Housewife Retired Student Unemployed

Job Title Occupation

Industry Type/Nature of Business or Work

Phone Numbers

Home Phone no. Mobile Phone No. Office Phone No.

Source of Funds

Are you related to any staff or director of the bank? Yes No

If yes, please state the bank’s staff/director’s name and how you are related.

Do you have any relatives that hold senior office (government, judicial, police, military)? Yes No

If yes, please state the name and how you are related.

Declaration and SignatureI/We hereby certify under oath that I/we have no past due obligation of any kind with any person or any loan/credit company or other persons.I/We hereby agree and authorize The Hongkong and Shanghai Banking Corporation Limited (HSBC), the companies owned by HSBC or under common ownership with it, otherwise known as the HBSC Group, and HSBC’s authorized agents to obtain, disclose or verify the information contained herein or in any document/paper submitted in connection herewith, as well as any updates or corrections thereof, to any person/s it may deem necessary, for as long as it is connected with and/or arising from this application, my/our HSBC credit cards and the use of/transactions involving my/our HSBC credit card/s including but not limited to any and all credit information service providers such as the Credit Card Association of the Philippines and the Credit Information Corporation. This authority includes verifications made with the SSS regarding my membership, employer and contributions (last contributed date and contribution amount).In respect of the authority granted above. I/we agree to waive any right under The Anti-Wire Tapping Act (Republic Act No. 4200) or any similar law. I/We acknowledge that HSBC shall take reasonable measures to keep the information confidential and privileged.I/We hereby agree to hold the Bank and the persons from or to whom the Bank shall obtain, disclose or verify the information contained herein free and harmless from any liability arising from the use of any such information, regardless of its previous classification as confidential under related contracts, and regardless of the effect to this credit card application.I agree and authorize the Bank to send any form of communication related to its products to me, unless I expressly notify the Bank otherwise.I/We hereby authorize the Bank to ask my/our update contact number from my/our personal reference.I/We hereby undertake to inform HSBC immediately of any change in any of the information/declarations contained herein or in the documents/papers submitted by me/us.I/We understand that this application form and documents submitted to HSBC will not be returned. I/We further understand that HSBC reserves the right to withhold any information about the non-approval of my/our application.

I/We hereby acknowledge and agree that, by signing this application, or by calling to request for card activation, or by signing or using my/our HSBC credit card, I/we signify my/our understanding of, and my/our agreement to be bound by, the Terms and Conditions for HSBC’s Credit Card Products. This includes without limitation my/our agreement to pay all charges and fees that fall due on my/our HSBC credit cards and my/our agreement to HSBC’s right, at its exclusive option and without prior notice to the CARDHOLDER, to restrain, suspend, cancel and withdraw or terminate any CARD issued and/or its privileges at any time for whatever reason.Fax Indemnity ClauseIn consideration of your agreeing to accept from me from time to time instructions purporting to come from me in the form of facsimile bearing a code agreed from time to time between us but not bearing an original signature (faxed instructions) in relation to my credit card application and/or account without requiring written confirmation in respect of any faxed instruction prior to acting thereon, I confirm that:(1) I am aware of the possible risks involved in connection with the giving of faxed instruction, including without

limitation, the forging of non-original signatures on the facsimiles, transmission of the instruction to the wrong numbers, that the faxed instruction may not reach the Bank or that it may become known to third parties; and acknowledge my understanding thereof.

(2) The Bank is hereby irrevocably and unconditionally authorized to act on any faxed instruction which in its sole discretion it believes to have emanated from me and the Bank shall not be liable for acting in good faith on such faxed instruction.

(3) The Bank is not under any duty to verify the identity of the person/s giving any faxed instruction purportedly made on my behalf or the authenticity of any signature thereon. Any transaction made pursuant to any faxed instruction shall be binding on me, whether made with or without my authority, knowledge or consent.

(4) I undertake to keep the Bank indemnified at all times against, and free and harmless from, all claims, losses and damages which may be brought against or suffered by the Bank arising directly or indirectly out of or in connection with its acceptance of, and action taken on, faxed instructions from me, whether or not confirmed in writing by me.

Signature of Primary Cardholder

D D M M Y Y Y YDate

Signature of Supplementary Card Applicant

D D M M Y Y Y YDate

Reference Number RBWM_December2016_GPS1570

Submission of Application Form and Supporting Documents

Submit your application form and supporting documents at the nearest HSBC branch.