Priority Pass Registration Form - ocbcwhmac.com

1 Priority pass Priority pass Registration form Pleas e c omplete the applic ation form in BLOC K LETT ERS and plac e a m ark w here applic able. CreditCreditCreditCredit Card No. - - - VI VA / W orld / VI SA F or VIV A Cred i t Ca rd / Wo rl d Ma ste rc a rd / VI SA or Mast er car d Pla t inu m C ar d o nly . / / / / Name in English / PortugueseName in English / PortugueseName in English / PortugueseName in English / Portuguese P riority pass * I w is h to apply for the m em bers hip of Priority P as s* C ard Account:C ard Account:C ard Account:C ard Account.

2 P rinc ipal C ard Suppl em entary C ard Princ ipal C ard and Supplem entary C ard * MOP 22 0 C ar dhol de r wi ll be c ha rg ed ap pro x imat el y MO P2 20 f or ea ch v isi t, it wi ll be d eb ited hi s C re di t Ca rd dir ectl y. C ardholder Signature _ __ __ ___ __ __ __ ___ __ _ _ ___ __ __ _ __ ___ __ __ _ __ __ __ __ _ __ __ ___ _ _ __ ___ ___ _ _ ___ __ __ _ _ ___ __ __ _ _ Da te : For Bank Use OnlyFor Bank Use OnlyFor Bank Use OnlyFor Bank Use Only A pprov e Input D ate P PP no.

3 S PP no. S. V.