HSBC Premier Credit Card Application
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1 HSBC Premier Credit Card Application Your Choice Please issue me/us an HSBC Premier Credit Card Security Code Employment Organisation Type Public Sector Multinational Co. Public Ltd. Co. Armed Forces Others Government/Ministry Partnership Private Ltd. Co. Proprietorship Salaried Salaried Self-employed Employment Status Both Both Others Salary Date For security reasons, please choose a word that we can identify you with Reference in Oman Name of a friend/relative Company Relationship Home Telephone Number Designation Work Telephone Number Mobile Telephone Number (not to exceed 10 characters) Supplementary Card Information Please issue an additional HSBC Premier Credit Card for the following applicants First Supplementary Applicant Additional Benefits Settlement Details Automatic settlement of HSBC Premier Credit Card bills Yes No HSBC Current/Savings Account number to be debited Relationship Spouse Child Parent Brother Sister Others (16 years and above) Second Supplementary Applicant Relationship Spouse Child Parent Brother Sister Others Monthly payment 5% Others (select between 5% - 100%) HSBC Premier Credit Card ATM Access Link my HSBC Premier Credit Card to access my account(s) I would like the supplementary cardholder to use his/her HSBC card at ATMs to access our HSBC account* Credit Shield Plus Credit Shield Plus is an optional comprehensive insurance benefit which protects the Cardholder's outstanding balance in the unfortunate event of Death or Permanent Total Disability and covers your minimum installment in the event of Involuntary Loss of Employment for employed eligible cardholders or Temporary Total Disability for self employed eligible cardholders. A fee of 0.60% of your monthly outstanding balance is charged for Credit Shield Plus. I would like to opt for Credit Shield Plus and acknowledge that the benefit is subject to terms, conditions and exclusions. Yes No Customer Signature Benefits are subject to the Terms and Conditions. For full details, refer to
2 Declaration I/We agree that the information given above is true and complete and that I/we have received the Bank s General Terms & Conditions, which may be amended from time to time for the Operation of Accounts and Electronic Banking Services, 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 Bank s General Terms & 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. Joint Accounts Only I/We acknowledge that the provisions for the joint account mandates are set out in the Bank s General Terms & Conditions. We note, that if we elect to use Personal Internet Banking Service, I/we will be required to accept the relevant Personal Internet Banking Service Terms & Conditions online. We agree that where we accept the Personal Internet Banking Services Terms & Conditions online, we will be agreeing to accept and be bound by them and any subsequent amendments, whether set out in English and/or Arabic. Credit Card Application I/We hereby apply for an HSBC Credit Card(s) and declare, that the information included in this application is true and correct and authorise HSBC to verify this from whatever sources that HSBC may choose. I/We accept, that HSBC is entitled in its absolute discretion to accept or reject this application without assigning any reason whatsoever. I/We acknowledge that the use of my HSBC Card and any Supplementary HSBC Card(s) issued on the Card account will be subject to the Terms & Conditions of the HSBC Cardholder Agreement (which may be amended from time to time at HSBC s sole discretion) accompanying the HSBC Card(s) and that I/we shall be liable unconditionally for the outstanding amounts of both Primary and Supplementary Card(s). I/We hereby authorise HSBC to issue a Supplementary Card(s) for use on my/our account(s) to the person(s) named who is/are over 18 years of age and agree that you can provide information to him/her about the account. I/We acknowledge that the accounts operated in conjunction with the Card service will be subject to normal Terms & Conditions which govern the ATM facility as stated in the HSBC Cardholder Agreement (which may be amended from time to time at HSBC s sole discretion). I/We have received a copy of the Schedule of Services and Tariffs and the General Terms & Conditions booklet Signing Instructions (Joint A/c only) Anyone Jointly Name Name Please ensure signature is within box provided in black ink only. For Bank Use Only Account Number Forms Completed Signed in my presence B/L checked Date account opened CSR name/staff identity Workstation ID Others Please ensure signature is within box provided in black ink only. CSR Initial Additional maintenance International Customer Number Relationship managed by KYC & SCC Checked (Sign) SCC Yes No Market Sector Code Bank Authorisation Signature HSBC Premier Credit Card limit(s) Existing HSBC Credit Card limit(s) New Credit Card limit(s) (pre-approved) Card Number Type Limit MC/VISA MC/VISA MC/VISA Cancel Cancel For Joint Accounts Customer Number 1 Customer Number 2 Bank Authorised Signature Remarks Bank Stamp Issued by HSBC Bank Oman S.A.O.G., P.O. Box1726, PC 111, CPO-Seeb, Sultanate of Oman. OMM/CMP/ Copyright. HSBC Bank Oman S.A.O.G 2014 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 Oman S.A.O.G.
3 Membership Form May 2014
4 Branch Date Your Personal Details Account Holder (1) Account Holder (2) Title Mr/Mrs/Ms/Others Mr/Mrs/Ms/Others First Name* Middle Name* Family Name* Passport/ID Number Country of Issue Issue Date cc / cc / cc cc / cc / cc Expiry Date cc / cc / cc cc / cc / cc Date of Birth (DD/MM/YY)* cc / cc / cc cc / cc / cc Country of Birth* Nationality Do you have Multiple Nationalities c Yes c No c Yes c No If Yes Nationality 1 Nationality 1 (Please provide multiple Nationalities) Nationality 2 Nationality 2 If No (Please provide only Nationality 1) Nationality 3 Nationality 3 Gender c Male c Female c Male c Female *As per passport/id Your Employment Details Company Name Address P O Box P C Country Office Location Job Title Department Employee ID Years with Employer Monthly Salary (OMR) Other Income (OMR) Household Income (OMR) Office Number Way Number Building Name/Number Street/Landmark Area/City P O Box P C Country Office Number Way Number Building Name/Number Street/Landmark Area/City Employer Economic Activity c Agriculture c Mining & Quarrying c Manufacturing c Electricity, Gas & Water c Construction c Whole, Retails Trade & Car c Hotels & Restaurants c Transport, Storage & Communication c Financial Intermediaries c Real Estate & Renting Services c Education c Health & Social Work c Community & Personal Services c Public Administration c Other Services
5 Your Contact Details Residence Type in Oman Own c Company-provided c Own c Company-provided c Rented c Living with parents c Rented c Living with parents c Others c Others c Residence Address in House/Flat Number House/Flat Number Oman Way Number Way Number Building Name/Number Building Name/Number Street/Landmark Street/Landmark Area/City Area/City P O Box P O Box P C P C Residing at this address since date If residing at the stated address for less than 3 years, please provide your previous residence address details Years at Current Address Home Telephone Number Private ID Mobile Number Work Telephone Number Work Fax Number Permanent Address in Home Country Telephone Number in Home Country Preferred Correspondence Address c Work c c Work c c Residence c Residence (Joint Accounts) Please mail all correspondence to the address of (please mark one only): Account Holder Number. 1 c Power of Attorney Will you be appointing a 'Power of Attorney' for this Account with the Bank? c Yes c No If yes, please provide the residence address of the Power of Attorney Preferred Type of Account Current c OMR c USD c EUR c GBP c AED Savings c OMR c USD c EUR c GBP c AED Mandoos c OMR Call Deposit c OMR c USD c EUR c GBP c AED TMD c OMR c USD c EUR c GBP c AED Number. 2 c Purpose of opening the account: Receipt of Salary Loan / Credit Card Repayments Savings Others (please specify) Please indicate the expected total value of monthly credits into the account OMR Source of Income HSBC Premier Debit card link A/cs Additional/New HSBC Premier Debit card* required Cheque Book(s) (if applicable) Quantity (25 leaves each) Personal Internet Banking/Phone Banking Service
6 About You (Thank you for taking the time to give us further details about yourself. We shall use this to serve you better.) You are Single Married Others and have dependants Your spouse name is and you have children Your children s name 1 Date of Birth (DD/MM/YY) 2 Date of Birth (DD/MM/YY) 3 Date of Birth (DD/MM/YY) Your Education level: Primary Secondary Graduate Post-Graduate Professional A/c Holder 1 Your Hobbies / Interests Car owner: Yes No Number of Cars Owned Your Education level: Primary Secondary Graduate Post-Graduate Professional A/c Holder 2 Your Hobbies / Interests Car owner: Yes No Number of Cars Owned Please provide me advice on the following insurance products Personal Accident Travel Term Home Contents Motor Education Plan Retirement Plan Please provide me advice on investment opportunities Yes No My Reference Details Previous Bank Existing Account Holder HSBC Staff Company Introduction Your Liabilities Bank/Company Name Monthly Instalment/Limit Balance Outstanding Personal Loan Home Loan Car Loan Overdraft Credit Card 1 Credit Card 2 Others Your Assets Value Bank Name Other Bank Current Account Other Bank Savings Account Fixed Deposits Property Shares Note : Any alteration on the personal account opening form has to be signed by the applicant(s). Documents submitted with the application are bank s property. *For Joint Account Holders
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