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LANDBANK EMV Chip Enabled Card Claim Form - 0 PDF

This document is an EMV chip-enabled card claim form from LANDBANK. It contains fields for the cardholder's name, contact information, card and account numbers. The cardholder commits to activating the new chip-enabled card within 3 days by changing their PIN at an ATM, waiving liability for unauthorized transactions if they fail to do so. It also includes a request to deliver the new card to another LANDBANK branch, waiving liability for issues in shipping. Signatures are required from the cardholder, an approver, and to acknowledge receipt of the new card.

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1K views1 page

LANDBANK EMV Chip Enabled Card Claim Form - 0 PDF

This document is an EMV chip-enabled card claim form from LANDBANK. It contains fields for the cardholder's name, contact information, card and account numbers. The cardholder commits to activating the new chip-enabled card within 3 days by changing their PIN at an ATM, waiving liability for unauthorized transactions if they fail to do so. It also includes a request to deliver the new card to another LANDBANK branch, waiving liability for issues in shipping. Signatures are required from the cardholder, an approver, and to acknowledge receipt of the new card.

Uploaded by

jths
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

EMV CHIP-ENABLED CARD CLAIM FORM

Cardholder's Name: (First Name, Middle Name, Last Name)

Email Address: Mobile/Phone Number:

Card Number: Account Number (if applicable): Reference Number:


( Please disregard this portion if card is being claimed at the Issuing Branch)

CLAIM AND WAIVER


I hereby commit to activate the new EMV chip-enabled card by changing my PIN at any LANDBANK ATM terminal
within three (3) calendar days upon receipt. In case of my failure to do so, I hereby hold the Bank, its officers and
employees, free from any liability or damages that may arise from the unauthorized transactions on my account.

REQUEST FOR CARD RELEASE THRU OTHER LANDBANK BRANCH


(Please disregard this portion if card is being claimed at the Issuing Branch)

This is to request for the delivery of my new EMV chip-enabled Card to LANDBANK ______________________
Branch. With this request, I hereby relieve the Bank, including its officers and employees, from any liability arising
from the loss, damage or delay of shipping due to force majeure.

Signature of Cardholder over Printed Name/Date


Bank's Copy March 2017

EMV CHIP-ENABLED CARD CLAIM STUB Reference Number:


Cardholder's Name: (First Name, Middle Name, Last Name) Card Number: Account Number):

Released by: Checked/Approved by: EMV chip-enabled Card Received by:

Signature over Printed Name/Date Signature over Printed Name/Date Signature over Printed Name/Date

EMV CHIP-ENABLED CARD CLAIM FORM


Cardholder's Name: (First Name, Middle Name, Last Name)

Card Number: Account Number (if applicable): Reference Number:


( Please disregard this portion if card is being claimed at the Issuing Branch

CLAIM AND WAIVER


I hereby commit to activate the new EMV chip-enabled card by changing my PIN at any LANDBANK ATM terminal
within three (3) calendar days upon receipt. In case of my failure to do so, I hereby hold the Bank, its officers and
employees, free from any liability or damages that may arise from the unauthorized transactions on my account.

REQUEST FOR CARD RELEASE THRU OTHER LANDBANK BRANCH


(Please disregard this portion if card is being claimed at the Issuing Branch)

This is to request for the delivery of my new EMV chip-enabled Card to LANDBANK ______________________
Branch. With this request, I hereby relieve the Bank, including its officers and employees, from any liability arising
from the loss, damage or delay of shipping due to force majeure.

Signature of Cardholder over Printed Name/Date


Customer's Copy

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