Corporate Payroll Card. Account Opening Form CORPORATE PAYROLL CARD FORM (To be filled by applicant only)

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Kristopher Alexander
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1 見本 Corporate Payroll Card Choice Bank Limited One Coney Drive, 3rd Floor P.O Box 2494 Belize City, Belize Phone: Fax: Account Opening Form CORPORATE PAYROLL CARD FORM (To be filled by applicant only) First Name:* Middle Name:* Last Name:* Date of Birth: Country of Birth: Organization Name: (DD-MM-YYYY) 1 母親の旧姓をローマ字で Mother s Maiden Name: Nationality TANAKA Employee Id: Permanent Residential Address. This must be a physical address. Post Office Boxes are not allowed. Army or Fleet Post Boxes (APO/FPO) are allowed. Correspondence Address: Residence Address: Please check box with if same as correspondence address Road: Area/Locality: City/Town: Mobile Number: Land line / Alternate Number: Address: Gender: Male Female Customer Declaration: Preferred Language: I have read and understood the terms and conditions specified for the corporate payroll card services by CHOICE BANK. Full details of terms and conditions of the corporate payroll card services by CHOICE BANK attached to this application have been made available to me and I agree to abide by the terms and conditions therein. I authorize CHOICE BANK to dispatch card & pin to the address of HRM Department / other authorized person of my organization. I confirm having received the Payroll Card kit with reference number... in a sealed condition. I further understand that the balance on my prepaid card cannot exceed `USD$10, 記入日を日日 - 月月 - 年年年年形式で記入 Customer Signature 鈴木一郎 3 パスポートのサインを記入

2 Name: Corporate Declaration: We hereby authorize CHOICE BANK to issue a Payroll Card to the person mentioned in the application form. We confirm that the person mentioned in the application form is employed / contractually employed with our organisation. Organzation Authorized Person Details Title Signature Signature & Company Stamp Documentation Please submit self attested documentation proof as applicable: Valid Photo-Bearing Identification which contains an unique identification number. Choice Bank accepts the following forms of valid and unexpired IDs according to Belize regulation, all of which must contain a photograph and signature Identity Proof (any one) Passport Armed Forces ID Card Social Security Card Voter s Card Driver s License; acceptable only when presented with an additional form of government issued photo identification Address Proof (any one) Documents Checked by (Name): Passport Phone Bill (Original if mobile) Corporate Confirmation For BANK use only Driver s License Electricity Bill Card Bank Statement Signature Documents Approved by (Name): Signature

3 Choice Bank Limited Prepaid Card Terms & Conditions Read these Terms and Conditions carefully and keep for future reference. For the purpose of these Terms and Conditions, the words we and our means Choice Bank Limited (CBL). The words you and your means the individual purchaser or user of the CBL MasterCard Prepaid. To purchase or to use a CBL MasterCard Prepaid or to sign a purchase receipt of same or sign an application for this product constitutes the acceptance of the Terms and Conditions or any other terms and conditions contained on the purchase receipt or on the card itself. DEFINITION Choice Bank Limited (CBL) MasterCard Prepaid Cards are cards with magnetic strips, which are acquired as alternative payment medium with minimum risk, and which do not incur nor pay interest. PROCESS OF PURCHASE The maximum reload amount per prepaid card is US$2, with maximum per prepaid card per month of US$10, In the application, you should determine the initial sum of the Card (s) in US Dollars. You can deposit additional amounts on your prepaid card in US Dollars, which will be added to the existing prepaid card processed by MasterCard. Your CBL MasterCard Prepaid Card allows you to access your funds from any MasterCard or Cirrus Automated Teller Machine (ATMs), MasterCard merchants that accept cards, on websites requiring payment via credit card or at any MasterCard issuer worldwide. The minimum value that you can purchase any single CBL MasterCard Prepaid Card is US$50.00 and the maximum value US$2, The value on the prepaid card must not exceed US$10,000. The minimum total that you can obtain from ATM is US$10.00 (or the equivalent amount in local currency of the country at the time of the transaction). Once the Card has been purchased, any query, information or assistance will have to be requested through the telephone numbers for Customer Service ( /6851) or via the website: PERSONAL IDENTIFICATION NUMBER The Personal Identification Number (PIN) is a 4-digit number of your selection, by calling Customer Service at 1(877) or via our website, to access your card. It is important that only you have access to this number and that you keep it in a secure place. It is best to memorize your PIN since it is the equivalent to your signature. This is a means of authentication and is required at merchants with pin capability.

4 In case you lose or misplace your PIN, immediately contact customer service. In the event you forget your PIN, you will be allowed a maximum of three tries in order for the card not to be deactivated. If your card is deactivated at the end of the third try, you will have to contact customer service to receive further instructions. LOST, STOLEN OR DAMAGED CARDS If your Card has been stolen, misplaced or damaged and you have forgotten or misplaced your PIN, please notify customer service at (866) and report immediately or via our website: Once the report has been made, your card will be blocked from use. If you are certain that you were the only one to have access to your PIN, it is optional to make a report of theft/misplacement. However, if you do not make this report it will be your responsibility for usage of the card. To the extent permitted by applicable law, we are not responsible for lost or stolen Cards or any unauthorized transactions made with the Card. You agree to give the notice described in this section that the Card is lost or stolen, and you should do so immediately to minimize your possible losses. See the section entitled "Your Liability for Unauthorized Transfers" in this Agreement for additional information concerning your liability for unauthorized transfers. You also agree, to the extent permitted by law, to cooperate completely with CBL and Customer Service in either of their attempts to recover from unauthorized users and to assist in their prosecution. YOUR LIABILITY FOR UNAUTHORIZED TRANSFERS. Tell us AT ONCE if you believe the Card has been lost or stolen. Contacting us by telephone at 1(877) or (501) is the best way of keeping your losses down. You could lose all the money on the Card. Also, if your periodic statement shows transactions that you did not make, tell us at once. If you do not tell us within ten (10) days after the periodic statement was made available to you, you may not get back any money you lost after the ten (10) days if we can prove that we could have stopped someone from taking the money if you had told us in time. APPROPRIATE USE All transactions done with your CBL MasterCard Prepaid Card and your PIN are equivalent to your signature, which is the only means of identification for the use of the card. Therefore, it is understood that the transactions were made by you or by someone on your behalf, unless you notify customer service of a lost/stolen card.

5 TYPES OF TRANSACTIONS AND LIMITATIONS You can use your CBL MasterCard Prepaid Card to access cash at any MasterCard Cirrus ATM Worldwide. All withdrawals will be deducted from your registered balance immediately. You can access your total available balance at a branch issuer of MasterCard Prepaid Card or MasterCard Cirrus ATM in any part of the world but it is important to consider that due to the different rules and policies of individual banks in certain countries, the ATMs may have a limit on the amount of cash it will dispense. YOU MUST ALSO TAKE INTO ACCOUNT THE FOLLOWING: If you do not wish to cancel the prepaid card, you must maintain a minimum balance of US$10.00 in the account and you can reload additional funds into the same card. When a minimum balance of US$10.00 or less is in your CBL MasterCard Prepaid Card, it will be deactivated. However, you can obtain the outstanding balance at CBL or MasterCard Cirrus ATM worldwide. Charges & Commissions # ITEM Fee 1 ATM Withdrawal Fee $ ATM Balance Inquiry/Transaction History $ ATM Transaction Decline $ Online & POS Transaction fee FREE 5 Online & POS Decline fee $ Plastic Fee (per card issued) $ Monthly Administrative Fee $ Card Load Fee $ Card to Card Transfer $ Card Replacement Fee (if lost/stolen/damaged) $ Inactive Fee (90 days) $ Dispute Fee $35.00 *A Fee of 1.8% will be assessed on all ATM & POS transactions. *A currency conversion fee of 2.5% will be assessed on all non USD ATM transactions. *A currency conversion fee of 1.8% will be assessed on all non USD POS transactions *Fees are subject to change without notice at the discretion of the Bank. DOCUMENTATION CBL will not be issuing statements detailing the transactions used by you. However, you can look up your recent transaction history (view the 5 current items) or pull up statements providing up to date and accurate balances on

6 If there is a transaction that was not authorized by you, you must immediately contact CBL via telephone or the website. ERRORS In case of errors or doubts over electronic transactions, please contact the service numbers or via the website as soon as possible so that the problem may be resolved. You have 30 days from the date transactions were made to present your dispute. In the event you wish to dispute a charge, you must provide a written letter explaining your case along with supporting documentation that you may have. ACTIVITIES These Terms and Conditions shall be governed by and construed in accordance with the laws of Belize and the parties hereto hereby submit to the jurisdiction of the Courts of Belize on any matter relating to these Terms and Conditions. CBL may change these Terms and Conditions at any time or times in its sole discretion whether or not a similar amendment is made to these Terms and Conditions with any other Cardholder provided that at least 30 days prior notice of any such change is given to the Cardholder and a variation so notified shall be binding upon the Cardholder Terms and Conditions. LIMITED LIABILITY EXCEPT AS OTHERWISE EXPRESSLY REQUIRED BY THIS AGREEMENT OR APPLICABLE LAW, WE WILL NOT BE LIABLE TO YOU FOR PERFORMING OR FAILING TO PERFORM ANY OBLIGATION UNDER THIS AGREEMENT UNLESS WE HAVE ACTED IN BAD FAITH. WITHOUT LIMITING THE FOREGOING, WE WILL NOT BE LIABLE TO YOU FOR DELAYS OR MISTAKES RESULTING FROM ANY CIRCUMSTANCES BEYOND OUR CONTROL, INCLUDING, WITHOUT LIMITATION, ACTS OF GOVERNMENTAL AUTHORITIES, NATIONAL EMERGENCIES, INSURRECTION, WAR, RIOTS, FAILURE OF MERCHANTS TO HONOR THE COMPASS MASTERCARD, FAILURE OF LOCHAVEN TO PROVIDE ANY SERVICES, FAILURE OF MERCHANTS TO PERFORM OR PROVIDE SERVICES, FAILURE OF COMMUNICATION SYSTEMS, OR FAILURES OF/OR DIFFICULTIES WITH OUR EQUIPMENT OR SYSTEMS. NOT IN LIMITATION OF THE FOREGOING, WE WILL NOT BE LIABLE TO YOU FOR ANY DELAY, FAILURE OR MALFUNCTION ATTRIBUTABLE TO YOUR EQUIPMENT, ANY INTERNET SERVICE, ANY PAYMENT SYSTEM OR ANY CUSTOMER SERVICE FUNCTION. IN THE EVENT THAT WE ARE HELD LIABLE TO YOU, YOU WILL ONLY BE ENTITLED TO RECOVER YOUR ACTUAL DAMAGES. IN NO EVENT SHALL YOU BE ENTITLED TO RECOVER ANY INDIRECT, CONSEQUENTIAL, EXEMPLARY OR SPECIAL DAMAGES (WHETHER IN CONTRACT, TORT OR OTHERWISE), EVEN I F YOU HAVE ADVISED US OF THE POSSIBILITY OF SUCH DAMAGES.

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