HSBC Premier Application Form

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1 July 2015 HSBC Premier Application Form Copyright. HSBC Bank Middle East Limited 2015 ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, on any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of HSBC Bank Middle East Limited. Issued by HSBC Bank Middle East Limited, PO Box 66, Dubai, UAE. Regulated by the Jersey Financial Services Commission and Central Bank of the United Arab Emirates. CRN:

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3 HSBC ACCOUNT OPENING APPLICATION - PREMIER Date: D D / MM / Y Y Y Y Branch: Where did you hear about this product? Internet Newspaper Billboards Direct Mail SMS Others... Account Type Current Savings esaver Premier Deposit Premier Salary Premier Cross border Premier by Mortgage Currency AED USD GBP EUR Personal Details Title Mr Mrs Ms Mrs Miss Dr Sh Sha Prof First... Last... Date of birth MM / DD / YYYY Gender Male Female Marital Status Married Family in UAE Married family outside UAE Single Widowed / Divorced / Separated Education Graduate Limited / None Post Graduate Primary Professional Secondary / High School Preferred Language English Arabic No. of Dependants... Identification Details Country of birth (as per passport)... Emirates ID No.: (Optional)... Passport number... Country of Issue:... Issue date MM / DD / YYYY Expiry date MM / DD / YYYY Do you have multiple nationalities? Yes No If Yes, please list them: Country of residence... Residence visa number... Residence visa expiry date MM / DD / YYYY Mailing Address Address line 1... Address line 2... Emirate / City...Country... Residence Address Flat no / Villa no / Building name / Street Name... Area... Emirate... Country... Time living in current address Years and Months. Contact number... If residing at the stated address for less than 3 years, please provide your previous residence address details Previous residence address... Flat no / Villa no / Building name / Street Name... Area... Emirate... Country...

4 Home Country Address House No / Flat No Street... Area / City... Postal / Zip Code... Country... Contact Details Mobile number (Country Code / Area Code / Number)... Residence number (CountryCode / AreaCode / Number)... Home Country number (CountryCode / AreaCode / Number)... address... From time to time, HSBC may wish to send you details of new products and services, promotions and special offers. Please select your preferred method of contact. You may select more than one method of contact. Telephone Yes No Yes No Direct mail Yes No SMS Yes No Joint Applicant Details: Kindly note that all joint applicants are required to have a valid UAE residence visa if applying for a current account Joint account 1: First Name:... Last Name:... Date of birth MM / DD / YYYY ... Joint account 2: First Name:... Last Name:... Date of birth MM / DD / YYYY ... Joint Accounts Only The provisions for joint account mandates are set out in the HSBC Personal Banking General Terms and Conditions as amended from time to time, which can be found at Signing Instructions (Joint Account only) JOINTLY (AND) EITHER (OR) Employment Details Type of Employment Salaried Student Housewife Self Employed Not employed / Non-resident What is your regular monthly income (AED)?... Approximately how much do you expect to deposit in your account over the next six months? (in AED)... Source of fund: Sale of property Rental Income Savings from Salary Investment proceeds Others... If Salaried / Self-Employed: Name of the Company / Employer... Industry...Occupation... Will you be transferring your salary to your HSBC account? Yes No How long you have been working with your current employer? Years and Months. Office contact No.... Office Address... Building Name / Street Address:... PO Box... Emirate... Country...

5 *If Self employed: Annual business turnover in AED:... Credit turnover in AED... Average balance in AED... Others Name on debit card Preferred Branch Receive free SMS alerts On all transactions on the acc. Yes No Cheque book* Yes No Premier Overdraft Yes No Declaration I/We agree that the information given above is true and complete and that I/we have read the HSBC Personal Banking General Terms and Conditions available on which I/we understand and expressly agree and accept to be bound by them whether set out in English and/or Arabic. I/We understand that the HSBC Personal Banking General Terms and Conditions for the Operation of Accounts and Electronic Banking Services shall apply to any personal account(s) that I/we may hold with the Bank from time to time. I/We note that if I/We use the Personal Internet Banking Service, I/We deem to have accepted the Personal Internet Banking Agreement which is available online at as amended from time to time. I/We agree and accept to be bound by the Bank s Schedule of Services and Tariffs as amended from time to time. A copy of the current tariff is available at * Please note that you can only have a cheque book if you have submitted a valid up-to-date UAE residency visa. Signing Instruction (for Joint Accounts Only): Single Jointly (AND) Either (OR) Customer Signature Account holder 1 Account holder 2 Account holder 3 For Official Use Only: Account Number: Date Account Opened: MM / DD / YYYY Verified / Approved By: Bank/ Branch Stamp & Authorised Signature:...

6 Personal Credit Card - Application Form Information provided in this account opening form will be used as part of the Credit Card application process if this is a product you decide to apply for. Primary Card (1) - Customer Emirates ID No. (Mandatory)... Card Type: HSBC Premier HSBC Black* HSBC Platinum* HSBC Platinum Select Name on Card: Payment Instruction: 5% 100% Others...% HSBC account to be debited: Primary Card (2) - Customer Emirates ID No. (Mandatory)... Card Type: HSBC Premier HSBC Black* HSBC Platinum* HSBC Platinum Select Name on Card: Payment Instruction: 5% 100% Others...% HSBC account to be debited: Your particulars of Borrowing from Other Banks / Finance Companies / Employer Total of the other overdraft amounts (AED) Total of the other credit card limits (AED) Total of the other Personal Loans monthly instalments amount (AED) Total of the other Auto Loans monthly instalments amount (AED) Total of the other Mortgages monthly instalments amount (AED) Supplementary Card (1A): Mr. Mrs. Ms. Others Relationship: Spouse Child Parent Brother Sister Other Card Type: HSBC Premier HSBC Black* HSBC Platinum* HSBC Platinum Select Name on Card: Mobile No.:... Payment Instruction: 5% 100% Others...% HSBC account to be debited: Supplementary Card (2A): Mr. Mrs. Ms. Others Relationship: Spouse Child Parent Brother Sister Other Card Type: HSBC Premier HSBC Black* HSBC Platinum* HSBC Platinum Select Name on Card: Mobile No.:... Payment Instruction: 5% 100% Others...% HSBC account to be debited: Supplementary Card (1B): Mr. Mrs. Ms. Others Relationship: Spouse Child Parent Brother Sister Other Card Type: HSBC Premier HSBC Black* HSBC Platinum* HSBC Platinum Select Name on Card: Mobile No.:... Payment Instruction: 5% 100% Others...% HSBC account to be debited: Supplementary Card (2B): Mr. Mrs. Ms. Others Relationship: Spouse Child Parent Brother Sister Other Card Type: HSBC Premier HSBC Black* HSBC Platinum* HSBC Platinum Select Name on Card: Mobile No.:... Payment Instruction: 5% 100% Others...% HSBC account to be debited: * An annual fee applies, in addition to HSBC Credit Card Agreement Terms and for HSBC Black Credit Card the HSBC Black Credit Card Terms and Conditions apply. The fees and charges set out in our Schedule of Tariffs apply. Please visit for more details. * An annual fee applies, in addition to HSBC Credit Card Agreement Terms and for HSBC Black Credit Card the HSBC Black Credit Card Terms and Conditions apply. The fees and charges set out in our Schedule of Tariffs apply. Please visit for more details.

7 Your Air Miles Relationship 1. Are you already an Air Miles Member? Yes No 2. If yes, your UAE Air Miles Card No. Limit on Supplementary Card(s) I would like to share my existing credit limit with my First Supplementary Cardholder Yes No Second Supplementary Cardholder Yes No If No, I would like to assign a credit limit of AED* If No, I would like to assign a credit limit of AED* Credit Card ATM Access (besides cash advances) I would like ATM access on my HSBC Credit Card at ATMs to access my HSBC account. Account Type Current Savings Account Currency AED USD GBP EUR I would like the Supplementary Cardholders to use their HSBC Credit Card(s) at ATMs to access** our HSBC Account. * When you specify the limit to be assigned to your Supplementary Cardholder, a one time set-up fee of AED 100 will be charged on your statement. The credit limit you assign to your Supplementary Card will be reduced from your existing credit limit subject to Bank policy. **This option is only available for supplementary cardholders above 21 years of age. Declaration of Primary Card Applicant I hereby apply for the issue of an HSBC Card and declare that the information provided in this application is true and correct and authorise HSBC to verify this information from whatever sources that it may choose. I accept that HSBC is entitled in its absolute discretion to accept or reject an application without assigning any reason whatsoever. I acknowledge that the use of my HSBC Card and any Supplementary HSBC Card(s) issued on the card account will be subject to the HSBC Personal Banking General Terms and Conditions and Credit Card Terms and Conditions accompanying the HSBC Card(s) available on (which may be amended from time to time at HSBC s sole discretion). I understand that by using the HSBC Card or Supplementary HSBC Card(s) I accept the HSBC Personal Banking General Terms and Conditions and Credit Card Terms and Conditions and that I shall be liable, unconditionally, for any amounts outstanding on both my HSBC Card and any Supplementary HSBC Card(s). Where an application is made now or in the future, I hereby authorise HSBC to issue Supplementary HSBC Card(s) for use on my account to the person(s) named who is/are over 16 years of age and agree that you can provide relevant information to the Supplementary HSBC Cardholder about the account. I accept that any account(s) operated in conjunction with the HSBC Card(s) will be subject to the HSBC Personal Banking General Terms and Conditions and Credit Card Terms and Conditions which govern the ATM facility as stated in the HSBC Personal Banking General Terms and Conditions and Credit Card Terms and Conditions available on I confirm that I have been made aware of the current benefits available in respect of my HSBC Card, including any free insurance benefits, and have been referred to the website for more information on such benefits, which may be amended from time to time at HSBC s discretion. Declaration of Supplementary Card Applicant I, the HSBC Supplementary Card applicant agree to be jointly and severally liable for all transactions processed by the use of the Supplementary Card applied for and issued by HSBC to myself and acknowledge that the use of my Supplementary Card will be subject to the HSBC Personal Banking General Terms and Conditions and Credit Card Terms and Conditions available on (which may be amended from time to time at HSBC s sole discretion) accompanying the Supplementary Card. I understand that by using the Supplementary Card I accept the HSBC Personal Banking General Terms and Conditions and Credit Card Terms and Conditions available on Signature For Official Use Only: A/C No:... Date Account Opened: MM / DD / YYYY Verified / Approved By: Bank/ Branch Stamp & Authorised Signature:...

8 Customer Acknowledgment I/We understand that in the event that I/we do not meet the eligibility criteria for Premier via the Joint Account, that can mean that I/we may be charged service charges for the joint account and my/our individual sole account(s) that are linked to the joint account. Details for service charges and eligibility criteria for Joint account can be found at: I/We agree that the information given in this form is true, accurate and complete. I/we confirm that I/we have been advised that by signing this form I/we accept and will be bound by the HSBC Personal Banking General Terms and Conditions and the Schedule of Services and Tariffs, as amended from time to time, the latest version of which can be found at I/we confirm that I/we have been advised to read the terms and the tariff sheet I/ We understand the minimum balance requirements & the relative charges as set out on our website I/We understand the funding criteria (12 months for Premier Salary and 24 months for Premier by Mortgage) else there is a possibility of charges and/or account re-classification I/We understand how to register for Internet Banking and Phone Banking I/We know that on registering for internet banking, all statements & messages will be provided as e-statements/ e-messages I/We understand that a new Salary Transfer Letter will be required on change of employment I/ We understand that to increase my/our 3 rd party fund transfer limit, I/we need to visit a Branch/CSU for activation post registering for phone banking I/We understand that to continue using my/our account facilities, I/we need to submit my/our UAE resident visa within the next 25 days. If I/we fail to submit my/our visa within this time, I am/we are aware that the bank may restrict my/our account operations and may proceed to close my/our account I/We understand that to continue using my/our Credit Cards facilities, I/we need to submit my/our Emirates ID card within the next 25 days, failing which I am/we are aware the bank may block my/our credit card and may proceed to close the card. I/We understand that any information provided in this form will be used for any Credit Card application I/We understand that the benefits and features are set out on our website and may be subject to change at any time at the Bank s discretion. Please ensure signature is within box provided in Black Ink only.

9 July 2015 PHONE BANKING PIN REGISTRATION INTERNET BANKING REGISTRATION Call Digit HSBC Account Number Registration Register Personal / Phone Banking Number PIN First 9 Digits* and add (0) Personal / Phone Banking Number PBN Call Create 6 digits Phone Banking PIN Order Secure key/ token * Not applicable for joint account holders. Call and activate secure key upon receiving it Copyright. HSBC Bank Middle East Limited 2015 ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, on any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of HSBC Bank Middle East Limited. Issued by HSBC Bank Middle East Limited, PO Box 66, Dubai, UAE. Regulated by the Jersey Financial Services Commission and Central Bank of the United Arab Emirates. CRN

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11 HSBC Black Credit Card Customer Acknowledgement Form Date: D D / MM / Y Y Y Y Branch: Customer Acknowledgment I/We agree that the information provided is true, accurate and complete. I/we confirm that I/we have been informed that by signing this customer acknowledgement form I/we accept and will be bound by the HSBC Personal Banking General Terms and Conditions and the Schedule of Services and Tariffs and the HSBC Black Credit Card Terms and Conditions (as applicable), as amended from time to time, the latest version of which can be found at I/ we confirm that I/we have been informed to read these terms and the tariff sheet I/We understand and accept that in relation to the HSBC Black Credit Card, an annual fee applies as set out in the Schedule of Tariffs as amended from time to time available at I/We understand that the benefits and features are set out on and may be subject to change at any time at the Bank s discretion. Please ensure signature is within box provided in Black Ink only. Primary Credit Card Applicant: Supplementary Credit Card Applicant (1): Supplementary Credit Card Applicant (2): Supplementary Credit Card Applicant (3): Copyright. HSBC Bank Middle East Limited 2015 ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, on any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of HSBC Bank Middle East Limited. Issued by HSBC Bank Middle East Limited, PO Box 66, Dubai, UAE. Regulated by the Jersey Financial Services Commission and Central Bank of the United Arab Emirates. CRN: July 2015

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