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Primary and Secondary Debit Card Application Form

This document is a Debit Card Application Form for Siinqee Bank, requiring personal and account details from the principal applicant and an optional secondary applicant. It includes sections for identification, contact information, and account preferences, along with a notice regarding card collection. The form must be signed by both applicants and includes space for bank staff to record data entry and approval.

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Nafyad Galaa
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9 views

Primary and Secondary Debit Card Application Form

This document is a Debit Card Application Form for Siinqee Bank, requiring personal and account details from the principal applicant and an optional secondary applicant. It includes sections for identification, contact information, and account preferences, along with a notice regarding card collection. The form must be signed by both applicants and includes space for bank staff to record data entry and approval.

Uploaded by

Nafyad Galaa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EMPOWERED.

TOGETHER

DEBIT CARD APPLICATION FORM

Branch

To be filled by existing account holder requiring Debit Card Principal Applicant

Full Name
(Mr./Mrs./Miss/Dr./Other (Note: Writing in English is Mandatory and Use Block Letter)

ID. No. Type of ID. Issued by

Date of Birth (Date/Month/Year) / / Gender Male ☐ Female ☐

Place of BirthAddress: City/Town Sub City Woreda House No.

Home Tel. Work Tel. Mobile E-mail

Bank Account details

Preferred account for your card: ☐ Savings ☐Current

Indicate another account to be linked to your card (if required).


☐ Savings ☐Current
Please indicate in the below box if you need or not a secondary card for your immediate family
memberswhich will be linked to your account. (If yes, please the below details should be filled by the
secondary Applicant.) Yes ☐ No ☐

By filling this form I agree to the terms and conditions of the bank.

Signature of Principal Applicant Date

_____________________________ _____________________

FOR OFFICE USE ONLY


Up on Data entry and Authorization in system
Data entered by______________________ Signature______________
Approved by: __________________________ Signature_____________

Siinqee Bank S.C.


Headquarters: Kazanchis, Odaa Tower, Addis Ababa, Ethiopia Tel: +251 115 571 118(46) | Fax: +251 115 571 157 | P.O.Box:
EMPOWERED. TOGETHER
19853 [email protected] | www.siinqee.com

Secondary Card Application Form


Specify type of relationship

Full Name
(Mr./Mrs./Miss/Dr./Other (Note: Use Block Letter)

ID. No. Type of ID. Issued by

Date of Birth (Date/Month/Year) / / Gender Male ☐ Female ☐

Place of BirthAddress: City/Town Sub City Woreda House No.

Home Tel. Work Tel. Mobile E-mail

In the case of joint card application approved those transactions made by one of the cardholders using
the card shall be accepted by the other.

Signature of Principal Applicant Signature of Secondary Applicant (If any)

Notice!
If you fail to collect your card within six months’ time from the date of this application, Bank will
destroy the card for your safety.

FOR OFFICE USE ONLY

Up on Data entry and Authorization in system


Data entered by______________________ Signature______________
Approved by:__________________________ Signature_____________

Siinqee Bank S.C.


Headquarters: Kazanchis, Odaa Tower, Addis Ababa, Ethiopia Tel: +251 115 571 118(46) | Fax: +251 115 571 157 | P.O.Box:
19853 [email protected] | www.siinqee.com

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