Exhibit A

MAINTENANCE REQUEST
FOR ATM CARD/PIN MAILER/E-GOV No.

To Branch/Unit AYALA AVE BANKMER Date

Please process:

Replacement of: ATM/Cash Card No./e-Gov No. Replacement fee of

under Account/Remmitance No. Php____________
to be paid via:

Reason for Replacement: Demagnetized/Damaged Card Captured Card

Cash
Lost/Stolen Stolen
Debit to Account

Replacement of: PIN Mailer Account Number:

for ATM/Cash Card No./e-Gov No.
Account Name
Reason for Replacement: Forgotten PIN Lost PIN Mailer

Reset my PIN/e-Gov No.

Deactivation of my ATM/Prepaid/Cash Card Number
Activation of previously reported lost/stolen ATM/Prepaid/Cash Card Number
Activation of Dormant (Inactive) WCC Account

Request for unblocking of ATM Card/e-Gov No. Date for reapplication of blocking of ATM card

Request for blocking ATM Card for E-Commerce/Internet Transaction

Start Date of Blocking End Date of Blocking

Request to change ATM card withdrawal and POS transaction limits.

P 30,000.00 P 50,000.00 ✘ P 100,000.00

Emboss my name on my card

Link my Cash Card to my Card No.

ACTIVATION OF INTERNATIONAL FEATURE

✘ Others, please specify

Conditions: 1 Loss due to fraud, fault, or negligence shall be for the account of the party guilty thereof.
2 Cardholder has witnessed the destruction/perforation/of the surrendered ATM/Cash Card (for demagnetized/damaged card).
3 For replacement due to lost/stolen card, the cardholder, by signing below, expressly declares that the card could no longer be
found/recovered despite diligent efforts. Further, the cardholder undertakes to surrender the above-mentioned card to Metrobank
should it be found/recovered. The cardholder agrees to indemnify and hold Metrobank, its officers and staff free and harmless from any
suit, action, liability, loss and/or damage that it may sustain by reason of cancellation of the aforementioned card.

4 For change of ATM card transaction withdrawal limits, the cardholder fully understands and aware of the corresponding risks involved in
changing the transaction limits.The new ATM card transaction withdrawal limits shall prevail and continue to prevail until and unless
METROBANK receives a new written request duly signed by the cardholder changing the ATM card transaction withdrawal limits anew.
The cardholder shall agree to indemnify and/or hold the Bank, successors-in-interest, directors, stockholders, officers, employees,
agents and representatives, free and harmless from any suit, claim, action, liability, loss and/or damage that may arise out of Bank's
approval and compliance with such request.

Cardholder/Client's Authorized Signatory (For PayCard)

Signature over Printed Name

For Bank's Use Only

Signature Verified By Approved By Reviewed By (For Card Replacement)
By signing below, I certify that the replaced card has been
HMD FBG properly tagged as "Cancelled" in the System.
N/A

MB-I-M-191-t/ Nov. '16