Eligibility Inquiry Form Covered Card

* All fields are mandatory fields

Type of Product Requested

Smiles Titanium Covered Card Cashback Titanium Covered Card

Smiles World Covered Card

Requested limit (AED):

Applicant Personal Information

First name: Last name:

Gender: Male Female Date of Birth:

Marital Status: Single Married Nationality:

Mobile Number: Passport No.: Expiry date:

Emirates ID No.: Expiry date: Email:

The information below is required by the Bank to determine eligibility criteria

Fixed monthly salary (AED): Variable monthly income (AED) (if any):

Residency period (number of years in UAE): Employment type: Salaried Self Employed

Name of company: Designation:

Length of service/Business establishment (in years):

Customer Consent and Declaration

I …..................................…..................................….......................................................................….................................. holding Emirates ID .......….........................................................................…..................................…....... hereby agree that:

• This information is provided to a third party vendor for the purpose of applying for Sharjah Islamic Bank products.

• I have no objection to SIB accessing my credit information from AECB (Al Etihad Credit Bureau) at any time. This information received by the Bank and
shall be used to provide different services and facilities to the customer from time to time.

• The Bank may obtain my bank statement through Central Bank of United Arab Emirates from time to time without any further consent.

• The Bank has the right to approve or decline my request according to its internal policies and procedures.

• Neither the Bank, nor its credit officers/relationship managers shall be liable for any disclosure of information.

Applicant name : .........................…..................................…................................................................................................…..................................…................................................................................................…..................................…...................................................

Signature: Date: .........................…..................................….........................................................................................

Sharjah Islamic Bank is licensed by the UAE Central Bank.

For official use only

Sales Agent code: SIB Sales coordinator:

SIB/Cust092-/V1/Dec/2021

Sales Manager code: SIB Team leader:

Agency name: Signature verified Email from applicant

 ‫ﻧﻤﻮذج اﻻﺳﺘﻌﻼم ﻋﻦ اﻷﻫﻠﻴﺔ اﻟﺒﻄﺎﻗﺎت اﻟﻤﻐﻄﺎة‬

‫* ﺟﻤﻴﻊ اﻟﺤﻘﻮل إﻟﺰاﻣﻴﺔ‬

‫ﻧﻮع اﻟﻤﻨﺘﺞ اﻟﻤﻄﻠﻮب‬

‫ﺑﻄﺎﻗﺔ اﻻﺳﺘﺮداد اﻟﻨﻘﺪي ﺗﻴﺘﺎﻧﻴﻮم اﻟﻤﻐﻄﺎة‬ ‫ﺑﻄﺎﻗﺔ ﺳﻤﺎﻳﻠﺰ ﺗﻴﺘﺎﻧﻴﻮم اﻟﻤﻐﻄﺎة‬

‫ﺑﻄﺎﻗﺔ ﺳﻤﺎﻳﻠﺰ وورﻟﺪ اﻟﻤﻐﻄﺎة‬

‫)درﻫﻢ(‬ ‫اﻟﺤﺪ اﻟﻤﻄﻠﻮب‪:‬‬

‫اﻟﻤﻌﻠﻮﻣﺎت اﻟﺸﺨﺼﻴﺔ ﻟﻤﻘﺪم اﻟﻄﻠﺐ‪:‬‬

‫اﻻﺳﻢ اﻷﺧﻴﺮ‪:‬‬ ‫اﻻﺳﻢ اﻷول‪:‬‬

‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‪:‬‬ ‫أﻧﺜﻰ‬ ‫ذﻛﺮ‬ ‫اﻟﻨﻮع‪:‬‬

‫اﻟﺠﻨﺴﻴﺔ‪:‬‬ ‫ﻣﺘﺰوج‬ ‫أﻋﺰب‬ ‫اﻟﺤﺎﻟﺔ اﻹﺟﺘﻤﺎﻋﻴﺔ‪:‬‬

‫ﺗﺎرﻳﺦ اﻻﻧﺘﻬﺎء‪:‬‬ ‫رﻗﻢ ﺟﻮاز اﻟﺴﻔﺮ‪:‬‬ ‫رﻗﻢ اﻟﻬﺎﺗﻒ اﻟﻤﺘﺤﺮك‪:‬‬

‫اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‪:‬‬ ‫ﺗﺎرﻳﺦ اﻻﻧﺘﻬﺎء‪:‬‬ ‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻹﻣﺎراﺗﻴﺔ‪:‬‬

‫اﻟﻤﻌﻠﻮﻣﺎت اﻟﻮاردة أدﻧﺎه ﻣﻄﻠﻮﺑﺔ ﻟﻠﻤﺼﺮف ﻟﺘﺤﺪﻳﺪ ﻣﻌﺎﻳﻴﺮ اﻷﻫﻠﻴﺔ‪:‬‬

‫اﻟﺪﺧﻞ اﻟﺸﻬﺮي اﻟﻤﺘﻐﻴﺮ )ﺑﺎﻟﺪرﻫﻢ اﻹﻣﺎراﺗﻲ( )إن وﺟﺪ(‪:‬‬ ‫اﻟﺮاﺗﺐ اﻟﺸﻬﺮي اﻷﺳﺎﺳﻲ )ﺑﺎﻟﺪرﻫﻢ اﻹﻣﺎراﺗﻲ(‪:‬‬

‫ﺻﺎﺣﺐ ﻋﻤﻞ‬ ‫ﻣﻮﻇﻒ ﺑﺮاﺗﺐ‬ ‫ﻧﻮع اﻟﻌﻤﻞ‪:‬‬ ‫ﻓﺘﺮة اﻹﻗﺎﻣﺔ )ﻋﺪد اﻟﺴﻨﻮات ﻓﻲ دوﻟﺔ اﻹﻣﺎرات اﻟﻌﺮﺑﻴﺔ اﻟﻤﺘﺤﺪة(‪:‬‬

‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‪:‬‬ ‫اﺳﻢ اﻟﺸﺮﻛﺔ‪:‬‬

‫ﻣﺪة اﻟﺨﺪﻣﺔ‪ /‬اﻟﻤﻨﺸﺄة اﻟﺘﺠﺎرﻳﺔ )ﻋﺪد اﻟﺴﻨﻮات(‪:‬‬

‫ﻣﻮاﻓﻘﺔ اﻟﻌﻤﻴﻞ وإﻗﺮاره‪:‬‬

‫أواﻓﻖ أﻧﺎ‪ ،........................................................................................... ،‬وأﺣﻤﻞ ﺑﻄﺎﻗﺔ ﻫﻮﻳﺔ اﻣﺎراﺗﻴﺔ رﻗﻢ ‪ ،......................................................................‬ﺑﻤﻮﺟﺒﻪ ﻋﻠﻰ ﻣﺎ ﻳﻠﻲ‪:‬‬

‫• ﺗﻘﺪﻳﻢ ﻫﺬه اﻟﻤﻌﻠﻮﻣﺎت ﻟﺒﺎﺋﻊ ﺧﺎرﺟﻲ ﻷﻏﺮاض اﻟﺤﺼﻮل ﻋﻠﻰ ﻣﻨﺘﺠﺎت ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ‪.‬‬

‫• أﻗﺮ أﻧﺎ اﻟﻤﻮﻗﻊ أدﻧﺎه ‪ ،‬أﻧﻪ ﻟﻴﺲ ﻟﺪي أي اﻋﺘﺮاض ﻋﻠﻰ ﻃﻠﺐ ﺣﺼﻮل ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ ﻋﻠﻰ ﺑﻴﺎﻧﺎت اﻟﺤﺴﺎب اﻻﺋﺘﻤﺎﻧﻴﺔ ﻣﻦ ‪) AECB‬اﻻﺗﺤﺎد ﻟﻠﻤﻌﻠﻮﻣﺎت اﻻﺋﺘﻤﺎﻧﻴﺔ( ﻓﻲ أي وﻗﺖ‪ .‬وﺑﺬﻟﻚ ﺳﻴﺘﻢ‬
‫اﺳﺘﺨﺪام ﻫﺬه اﻟﻤﻌﻠﻮﻣﺎت ﻟﺘﻮﻓﻴﺮ اﻟﺨﺪﻣﺎت واﻟﺘﺴﻬﻴﻼت اﻟﻤﺨﺘﻠﻔﺔ ﻣﻦ وﻗﺖ ﻵﺧﺮ‪.‬‬

‫• ﻳﺠﻮز ﻟﻠﻤﺼﺮف اﻟﺤﺼﻮل ﻋﻠﻰ ﻛﺸﻒ ﺣﺴﺎﺑﻲ اﻟﻤﺼﺮﻓﻲ ﻣﻦ ﺧﻼل ﻣﺼﺮف اﻹﻣﺎرات اﻟﻌﺮﺑﻴﺔ اﻟﻤﺘﺤﺪة اﻟﻤﺮﻛﺰي‪ ،‬ﻣﻦ وﻗﺖ ﻵﺧﺮ دون أي ﻣﻮاﻓﻘﺔ أﺧﺮى ﻣﻨﻲ‪.‬‬

‫وﻓﻘﺎ ﻟﺴﻴﺎﺳﺎﺗﻪ وإﺟﺮاءاﺗﻪ اﻟﺪاﺧﻠﻴﺔ‪.‬‬

‫ً‬ ‫• ﻳﺤﻖ ﻟﻠﻤﺼﺮف اﻟﻤﻮاﻓﻘﺔ ﻋﻠﻰ ﻃﻠﺒﻲ أو رﻓﻀﻪ‬

‫ﻣﺴﺆوﻻ ﻋﻦ إﻓﺸﺎء أﻳﺔ ﻣﻌﻠﻮﻣﺎت‪.‬‬

‫ً‬ ‫• ﻟﻦ ﻳﻜﻮن اﻟﻤﺼﺮف أو أي ﻣﻦ ﻣﺴﺆوﻟﻲ اﻹﺋﺘﻤﺎن‪/‬ﻣﺪراء اﻟﻌﻼﻗﺎت‬

‫اﺳﻢ ﻣﻘﺪم اﻟﻄﻠﺐ‪............................................................................................................................................................................................................................. :‬‬

‫اﻟﺘﺎرﻳﺦ‪...................................................................................... :‬‬ ‫اﻟﺘﻮﻗﻴﻊ‪:‬‬

‫ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ‪ .‬ﻫﻮ ﺟﻬﺔ ﻣﺮﺧﺼﺔ ﻣﻦ ﻗﺒﻞ ﻣﺼﺮف اﻹﻣﺎرات اﻟﻤﺮﻛﺰي‪.‬‬

‫ﻟﻼﺳﺘﺨﺪام اﻟﺮﺳﻤﻲ ﻓﻘﻂ‬

‫ﻣﻨﺴﻖ ﻣﺒﻴﻌﺎت ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ‪:‬‬ ‫رﻣﺰ وﻛﻴﻞ اﻟﻤﺒﻴﻌﺎت‪:‬‬

‫‪SIB/Cust092-/V1/Dec/2021‬‬

‫ﻗﺎﺋﺪ ﻓﺮﻳﻖ ﻣﻦ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ‪:‬‬ ‫رﻣﺰ ﻣﺪﻳﺮ اﻟﻤﺒﻴﻌﺎت‪:‬‬

‫ﺑﺮﻳﺪ إﻟﻜﺘﺮوﻧﻲ ﻣﻦ ﻣﻘﺪم اﻟﻄﻠﺐ‬ ‫ﺗﻢ اﻟﺘﺤﻘﻖ ﻣﻦ اﻟﺘﻮﻗﻴﻊ‬ ‫اﺳﻢ اﻟﻮﻛﺎﻟﺔ‪:‬‬