ovata ener AMERICAN EXPRESS CREDIT CARD APPLICATION FORM, 7 CRED eb gely rn ns nao ‘+ branch App. No, Di svenen F] ost [other customer Tye 1 new exiting cotave Lleatrsenstve customer taising chy Bankcard J amex CJ vis [F] mexcorpoate [others EWA campaignname + DSt/Employee Code Reference code ate CO yan to any orien |} ou [cae [pus] cond Lovee ESAS ‘Om Om Ooms. DD otter cender EJ mate] remte + Your Full Name ty sas come (rer) Nickname ional 10 No. bate of ith + Pace of ith Nationality Name on Passport Baggport sue tssue Oate iy Date Passport No Cotter Documentation smortatsites — [E] sree [E] mares E] overces ——trspouseemotove? [[] ves [I] no + No.of dependents + Educational Quatfetion Di roscrasiate FE] crduste E] use DD otter Contac No. +88 fail “Fathers Name + Mothers Name + Spoutds Name contact No. 8 Protesion feneev + Your name as you woul ke it to appear onthe card {sav ne spacebeteton ven, nate te oars) scarownershis [] ownes [1] ravens [] omceprowses [] wi Number of cars |; How doyouwanttoreceive —[]]Fromctranch I from bran, please wit the name of the branch theca? LD rreuth courier “inte vet crsmomter segs to recta the creat cadin ther aun acs the Carnet asune epost iy Bonk i ce alee ns ander any eof {errr ofoubsenoteny fhe ie ead iecneedbyomane pte Cranenser ithe Caronerbe aR obo ary soe ronal oto mee orang cut oN Ea + Your Residential Status 7 ownes [] Family onnes [F] company srovses [[] rented [1] otter “Residential Address rented, rental per monihin Tk Nearest Landmark + Distiet ty Post cade “+Area/ Police Station “Res dence Phone No No.of month at erren adress . vss Aa a a ‘Your Permanent Address (eeinpapont| ‘Area Police tation Neatest andra You are Di sataried LZ] settemployes Li busnesenan/iusiats: Cand owner ‘Employment status [I] Permanent [1] contactuat [] partTine ‘Date of ning «oes ares soy — hoe sone sen nent Bera corer pe D1 Proprietorhia [7] partnership [1] umited company * Total work experience in months oso, cash % credit * «+ Work experience in curent organization in month(s) No. of Employees persons ofce Premisesstatus [J owned [1] rented [1] teased [] other Busnes eabaner te Ne ot eh wth met nition Business Figures Details: Year. Year, ‘Year. Getto Ama roi Anna Turnover RSM) Totes astess — [E]resdentaladires — ] permanent adress oe + you are salaried Bsc (monty) Te Alowances (monthly Tk ‘otal (month) Te «tt youare setemployed {ress income (monty) Tk Expenses month) Tk et Income Tk. Additional monthly income Mery att revere documents) Source of other income Income of spouse Te other income oN. Ola TIN No. Pane astReference + Reference Name + Occupation + Residentia status [1] owned [Z] Family owned [2] company provided [[] tented [F] other natoratty + Relation wth apoio (mice Res. Prone 88 Mobile No, +86 mall + Residential dees ‘ees / Poie Staton Company Name Company Adress 7 HINA ve 7a a a 2nd Reference "Reference Name + Occupation ‘residentitstaus [] owned [I] Family owned [] company provided [Z] rented [] other netoraty + Relation with apleant (ce Res Prone 88 + MobieNe. 88 Ena + Rosidnil Ades ea / ote Staton + Company Name company Adeess [1 E-statements(€-Staterents wil be sent tothe email adress mentioned in the ‘About Yourset” section.) Ly Forhardcopy statement select anyone) —[] office adress [T] Residence adress Bank Name NC Warne ctype ACN. Aesince 1 2 Ae St Bankname IC Name ‘Account No. |AlCType —_Disb.Amount Instalment Amount Outstanding Amount 1 2 DETAILS OF OTHER CREDIT CARDS Py Clent10 consumer crests CardType Membersir Bonkname fs.05 gs laos corso Type [Mentor Soc 2 ae SL Security Type Baneficary Rate AvCrinrurentNo. Bank Name Issue Date Face Value Present Value 1 EI Monthy payment [T] Ys I wove to have my Cy Sank aeeunt automata dite each month or payment of my Ce Cred ds oo: Li mammamourtase [5] toovetouettsina tei en, you acount il be deed forthe (ty Sank Account No. for 80 ‘oun No2 for USO Branch ame SUPPLEMENTARY CARD APPLICATION NO.1 (ENJOY TWO COMPLIMENTARY SUPPLEMENTARY CARDS)* Ow Om ms Done a ee Name of Supplementary Care aplcat ESAS Mame. Supplementary Cord applicant 2 you woud lke ito appear on the card National 10 No, Nationality Rettonsipwihshe Primer] ssoue [] ren: [] sing E] cott ater PassprtNo AQ moans "a a a EU a oateot xe» Place of ih ‘caupaton Sow /name Mathers name dares ‘ee Poln Saon Date /ty Peet Code ‘Would you lke to set up 3 s of local Credit limit anc Email {roame ete Dive the Hollocalc 4 Email Spleremary cara? Dw % of USD Creat iit MobieNo, +88 EU Om Om Ome LD otter ender = [J mele =] Female Name of supplementary a seek dapget supplementary San spotty youl ke to open aonaty aor No Relationship withthe Primary [T] spouse [1] rorent (J siving [] cus other Passport car oppcant Date of ih Maceo th ‘ceupston fathers rome osname rs eer co Sears ‘Pole Saton sweety ot Code Would you et setup a ves flea Cretan a you he tet Oe m ‘ofl Credtintand Ena Splememary ca? Ow % of USD Cred iit MobleNo. +88 PHOTO Pema Cad Appear Supplementary Card opleantNo.1. Supplementary Crd Appear No.2 Please attach cet olor Peaesttch recent color Please attach ace olor pation ie photograh ihis posspart ste photograph nhs pation te photograph mths fo write yourname onthe Bock oe wie your ame one bask {ox wrt yourname on he ack othe protgaoh of ee pote the protogrash. BE Sin within ares, tse black nkcony Primary Card Applicant Supplementary Card Applicant No.1 Supplementary Card Applicant No.2 Ana es | te Supplementary Cardappicont, gree tobe joint and separately lable toat transactions procesred bythe ue ofthe Cardapplesforanseuedby CBLtothe Primary Cardapaicantand/ortomyl,andtobe bound bya the terms ane condivons ofthe Bank’ sCrecit Cars A@reement ‘Sgrature of Supplementary Card Applicant No.1 ‘Signature of Supplementary Card Applicant No.2 ate ves aa a a PIM hereby apply fer Armenian Exess ret Cada edorethat the rfomaton rede inthis apleation treat cree ane |shalladise yous any changes eet L.nrtyauthanze Te Cty Bank Lite veity any irtermatin tom whatever sourees may cans’ prepa Lace: ta The Cty Bank Lined even osehite Sr sal at be eure fore: setnaage an gre thal Ie sage lhe mar Care sneer Supoementry Cart) sy. ssud any secert salle dees Ss 3 Sepuanceottheirme and Conaion oe sacar ease uhehiay be riences oritme ote) a sie’ oneal earespngerceconmsned 9 (o cabrted ierendebo)secompann te Senate atdoedinte Bs ai oa count ere (ont peri: Dvir raed tne sy ah aclcaetpndnca raced ‘conte ans accep: that hers ane Conetonseeteaherenabores bt te charge fom sme ttine a Banks escatan ad lundeake seep met unde wt ahd Secure persn()nared woe unsere er ‘fstjeu may pone ntrmatntahm/her baste seo. hea the Sipplmentay Cae tpplesnte someon bane ye Shatloe mace nae my spelen anacarca heey. are to ndey te ty Baie akanst ns drate resp unaetae nah iy of eostneure bythe Sano ace of ny trench tyre on te upatemtary Career) af ie aloresnie Canaan: oy ate” fems ane Canaan tte ve Bark ie cacren ios, NDF ot cmmuneste taut ay er aticameaur se atee sooo by veazon oan gal ably or neanety ate Seplerentay Ca member lea sndertare tat oe ‘Stpatriary Care fees sab sled my Stet end sal be my prime’ espns tone charges mee onthe Sappietay Card. The contain oe inemsesnipel be Supstemaraty Carrere) a be eepenent one contncaton ny merce ama are ht iy Sie Insurance Coverages ee oe beng the Peary Csdmambet- wth THE CITY BANK AMERICAN EXORESS® CREDITCARD. haveuncerstond the Tes Canetars Exelon ng Benefits ts vale Protection chev ein aged betneen 8 sd 7,|apreeres| lte ting lo Te Cy Bare Lederer, {tered iy til nerare program autershenlyupanspening yore Cad scaur andl unce'stan sath aernne fh mapheale "othe eanceqenee 39 Stearns or oan accent reared pra tomy enter the surance Scere hereby autor the surance Company to very ern a reson wth he haere Scheme wom naever sources ay conse spree Leb gree that ll tatenens whether rough estatener seve rave rans transis seri he San fo THE ITY BANK AMERICAN EXPRESS® CREDITCARD ‘alle stented sod celeay me etre ana sneie Idee tat onl al sey objeto apna at Gon on fs areing tate re an ul acept ne akan Fesponsiy of statmensvanseted by Se Bank: Tre Ba ows ot naar ago exer tor ating the pitay ane sec of ra degintera vars Ith oe apap Bo agreed aes eat petewane eb was ee tra cote eps enna eg 0 te ‘iseontation oh felt cards Disten The cy Bark Lmtea Aan Cerer (th lou) 2/8 Dbz 7A, Daa 1000 The Bark shal al lable response ft cata erro ceo ona” tercepionef he oration open an th Barkreseres te gt ope vey eh ematon Hay te oie ano oy re amas aay that am pang er aCe rand Crd (rertaraas "ete te Appleton seed your Apa”) aca ts delat ahozes th Bank teshueyeibwmlogeeareaPvin teen t eect nescence te merons seweh eben Pape ry en ie haray cele hat Ve halle uncer 2 alga erst he Care Des /Ovstndng eye ned enerse th Sank ay tke sporop ale lplacon gst Iran Th Baayen rigs en acetone spre nese ro leapath manne by ess wthhe Bark "ray understetthe ann eh pty te Banat set one onthe erent my ardor dzconeuston the ane CES ena promise to say on demande The Cy dak mites or order the um of BT ‘ha ony). Forvalue received wth irtrest thera oF Percent per annum with moni rts ot such rats ay be Foedby The Cty Bonk Limited rom time ote CER ‘bo youwart AMERICAN BxPRESS*CARO Cheque Book? [7] ves [] no DSU ee am aware hat Cy Sel surance Coverages rile forme being th rary Carmember wth he Cy San Xeric Expres Ce Car. Rave unetod he Terns (onatons, fxcusions and Bones of is valabe insurance Sener Berg gee betweon 18 and 75, grea, es state wrongs The ity Sank Les otherwise, gat ‘rrted nt Ci Se isranc rogram automat ypo opening of rest Cad acount an unestan tha his nstance nt aplaslet the cansequences ot $ teknee or af an aceidens neues proto my envlimetin the insrance sche anim Car ages Seca nord fr 2) arth | hort authorie te Isurence company to very the informasanin eston wih th nance Scheme am what suresit may eoneder apPopsats CEASE I/We here assign he benef of Cy Shel surance to Name of Benefiory (es and percentage Share of Bont « Name of enefiary Benefit Relation CARDMEMBER’S DECLARATION ON THE RIGHT TO SET OFF ‘Ths declaration orm wil be corsered a the integral art of the main Carl Aplin Form (a) nadationto ay general ghost others contre the ao the Bar, Te Caremenber grees that the Bankr in aso dsteon aay te rd witout noice combine and console lor ary accounts hl ether ndvuaiy ony, of te Carrere with the Bank of whatevsdeserpson and wherever Toeted and whatner in Tata rn any ae eureny se of rUanse an sum standing tothe eed of any such aecous iudng ot acourt with ypplementry Caramemberin a owars achat fall ums dua tthe dank unser ary szaurs) of the Carrerer mith te an of whatever eaetpon or wherever oe 3d \whathern Takao any the currency a may go sonotwhstanding that the aiances such account] andthe ardmerser hereby autores the Bro oe an sich mbinnton onsodatio, eto or aster withthe ncesarycooverion atte Ban’sprevlng exchange ats which habe deteraned by the banka sable Sreeton, (61 For the purpose of enabing the Bank to preserve intact the ty of ary pany ncn the Cardmarerorce 2 Wie or Surman has been sued or prove the ankrupty or insolvency ofthe Cardmanoer or for such other easne athe an dee fhe Bank ay sy tmeon place ndheep such mee the dannay ink pret any mones recived recovered of ealued hereunder under any he Seer Guanes tthe eet othe Caramerr othe Banks deem two ry icermea at obgaton on te parc te Banko apply he sme oa pat theeot nor towards the dacharge of tha sums ue and owingo te Bank. an sm confeing that cei Lam ata delat of any bank or oy Banc ntti 2 vests MMIII 7