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    Pagala Ala

    Uploaded by

    Mark Dee
    This document is a credit card payment form for insurance premiums with BPI MS Insurance Corporation. It provides details on payment options including installing the premium over 3, 6, 9, or 12 months with 0% interest for certain credit cards. The requirements include a photocopy of the credit card and ID of the cardholder. The terms and conditions specify that the insurance premium will be charged to the enrolled credit card and that the cardholder is responsible for enrolling a new credit card should the original card be cancelled. Installment options are available for qualifying BPI, HSBC, China Bank, and BDO credit cards subject to credit approval.

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    © All Rights Reserved
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    Pagala Ala

    Uploaded by

    Mark Dee
    56 views2 pages
    This document is a credit card payment form for insurance premiums with BPI MS Insurance Corporation. It provides details on payment options including installing the premium over 3, 6, 9, or 12 months with 0% interest for certain credit cards. The requirements include a photocopy of the credit card and ID of the cardholder. The terms and conditions specify that the insurance premium will be charged to the enrolled credit card and that the cardholder is responsible for enrolling a new credit card should the original card be cancelled. Installment options are available for qualifying BPI, HSBC, China Bank, and BDO credit cards subject to credit approval.

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    Pagala ala

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    This document is a credit card payment form for insurance premiums with BPI MS Insurance Corporation. It provides details on payment options including installing the premium over 3, 6, 9, or 12 months with 0% interest for certain credit cards. The requirements include a photocopy of the credit card and ID of the cardholder. The terms and conditions specify that the insurance premium will be charged to the enrolled credit card and that the cardholder is responsible for enrolling a new credit card should the original card be cancelled. Installment options are available for qualifying BPI, HSBC, China Bank, and BDO credit cards subject to credit approval.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    56 views2 pages

    Pagala Ala

    Uploaded by

    Mark Dee
    This document is a credit card payment form for insurance premiums with BPI MS Insurance Corporation. It provides details on payment options including installing the premium over 3, 6, 9, or 12 months with 0% interest for certain credit cards. The requirements include a photocopy of the credit card and ID of the cardholder. The terms and conditions specify that the insurance premium will be charged to the enrolled credit card and that the cardholder is responsible for enrolling a new credit card should the original card be cancelled. Installment options are available for qualifying BPI, HSBC, China Bank, and BDO credit cards subject to credit approval.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    F-C&C-033

    Revision 02
    January 09, 2023
    CREDIT CARD PAYMENT FORM
    INSURANCE INFORMATION
    *Customer Name:

    Home Office
    Mobile Number:
    Number: Number:
    Email Address:
    Policy Number:
    Insurance Premium Due:
    Policy Inception Date:

    Bank Name:
    Cardholder Name:
    *Customer Name and Credit
    Cardholder name should be the same

    Card Number: Expiry Date:


    (Month / Year)

    PAYMENT INFORMATION
    Mark (X) the payment option you wish to apply.
    Charge my insurance:

    ☐ Via Installment: (Minimum Insurance Premium Due of Php3,000 for 3, 6 & 9 months)
    (Minimum Insurance Premium Due of Php15,000 for 12 months for
    BPI/BFB issued Credit Card)

    Real 0% Installment 0% Installment


    (BPI/BFB Credit Card) (BDO/HSBC/China Bank Credit Card)

    ☐ 3 months ☐ 3 months
    ☐ 6 months ☐ 6 months
    ☐ 9 months ☐ 9 months
    ☐ 12 months

    ☐ Straight charge (One-time payment using any Visa or MasterCard credit card)

    REQUIREMENTS
    • Photocopy of the Credit Card (front only)
    • Photocopy of the Cardholder’s valid government-issued ID with signature
    IMPORTANT REMINDER: Insurance Premium Due, Policy Inception Date and payment options are subject to validation at the time of charging. Please submit this
    form to the BPI MS Insurance Corporation office nearest you.

    I agree to be bound by the Terms and Conditions of this form. I certify that the information provided here are true and
    correct.

    Cardholder’s Signature over Printed Name


    BPI MS Policy Terms and Conditions
    1. The Insurance Po l icy premium to BPI MS shall be paid through the enrolled credit card.
    2. Charging of the Insurance Premium due against the enrolled credit card is based on the chosen terms, if any.
    3. In case of failed charge payment for the enrolled premium, BPI MS will contact the cardholder to inform him/her of the
    unsuccessful attempt.
    4. Cardholder is aware that the enrollment to this payment facility is active and in-force for the duration of the policy coverage.
    5. In case of cancellation/expiration/termination of credit card, cardholder must enroll another credit card.
    Failure to enroll another credit card shall not give rise to any liability on the part of BPI MS if the policy is cancelled
    for non-payment.

    Credit card Installment Terms and Conditions

    1. BPI MS credit card installment payment is open to a cardholder with good credit standing of the following cards:
    • BPI Credit Cards (Blue MasterCard, Gold MasterCard, Petron-BPI MasterCard, BPI WorldPerks MasterCard, BPI
    SkyMiles MasterCard, BPI SkyMiles Platinum MasterCard, BPI Amore Visa, BPI Amore Visa Platinum, Edge
    MasterCard, and BPI Family Credit Cards)
    • HSBC Red MasterCard , HSBC Premier World MasterCard, HSBC Platinum Visa, HSBC Cash Back Visa, HSBC Visa
    • China Bank Prime MasterCard, China Bank Platinum MasterCard, and China Bank World MasterCard
    • BDO-issued Visa and MasterCard credit cards
    2. Cardholder can avail of the 0% installment subject to the submission of the required forms and approval within the agreed
    turnaround time.
    3. To avail of the products and services, cardholder must either:
    • Personally present his/her credit card to any BPI MS Insurance Corporation office and sign the charge slip when the
    transaction is approved; or
    • Fill out the Credit Card Payment Form and send it to the nearest BPI MS Sales Office.
    4. The terms and conditions governing the issuance of BPI/BFB, BDO, HSBC and China Bank Credit Cards, and the reminders
    and other provisions contained in the card carrier, statement of account, charge slips and other documents or instruments,
    which are made an integral part hereof by reference, shall likewise be resorted to in instances where they are applicable.

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