CTBC BANK
PENS SERRAT
CASH CARD APPLICATION FORM
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fy saning this Cash Cara Agpcaton Fon | rn appying for a CTEC BANK Cash Card tobe used fo gan access to raneactonerequsng the use of @ Via Cash Card
"hereby cety that have ead a agree to abs and ba bound oth era and condons governing tna ash Card Fac anda ture emendmant hee a wel oe he
‘arms and conan i the fevers page of hi for Liat, so ery thal a infmatnheran ann al aupporing documents submites together with ths sppleton
are tue and coret and ayes that they shal roman CTBC BANK’s property |hereby autherze the Prncipal Account Ose andor CTE BANK andor is represeriatve 19
‘abcess, ver or estgote ery and al rtrmeton furished by mel,
ere waive any sea of my ahs to confiertiy of formaon under R.A 1405, a amended, RA, 6426 an such other sao ad repustory proisions relating oat
‘sng tom my applesten fora Cash Car, asthe dscosure's necessary an eleva tm comple he ransactons desfeeby CTC BANK ana ne Primary Aecout Welds
"umnaze CTBC BANK, vthet sty futher eanset ra any noes ne earenc ome, io alos an prose anys al iration ing Fam and in caieco fh
‘spplcaten forthe kauance ofa Gath Card wheter cr ot prove by tne or acessed r verted by CTRC BANK, or may have crm tothe Knonledg of GTEC BANK inthe
ours of verFcaton, oan of afltos, vondor, andlor subsite.
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‘CARDFOLDERS SIGNATURE ABOVE PRINTED RANE aE
‘CARDHOLDERS SIGNATURE ABOVE PRINTED NANE ORE
Remar Release Ot
Branch of sount Prsceased by Feprved by
Client's Copy‘TERMS AND CONDITIONS GOVERNING THE USE OF CTEC BANK CASHCARD
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