CITY BANK AMERICAN EXPRESS CREDIT CARD APPLICATION FORM Sales & Service Center Date DSE/Eploee Coe # File Serial # Branch DST Application Coe Group Sales General Instructions: Use CAPITAL LETTERS Tick boxes as appropriate an write N/A where not applicable to ou Countersign all changes or corrections ou ake About our application I want to appl for Cit Bank Aerican Express Creit Car (Local) Cit Bank Aerican Express Creit Car (Dual) Cit Bank Aerican Express Gol Creit Car Cit Bank Aerican Express Platinu Creit Car For Existing VISA Carholers [Please rea below instructions carefull before ou fill up this portion] Do ou have a Cit Bank VISA car? If es, please fill in the below inforation: Your Full Nae (as in passport /ID) Cit VISA Car. Expir Date: Car Liit 1. As per Banglaesh Bank regulations, our total liit in both cars (Aerican Express & VISA) ust not excee Tk. 5,00,000 - & put together. Uner those circustances, please inicate our Aerican Express an VISA car s liit split below: Aerican Express Car Liit Tk. VISA Car Liit Tk. 2. Please inicate how ou want us to split the total liit between two currencies ( & - liit cannot excee 7,000 uner travel quota rule) Aerican Express Car Liit VISA Car Liit About ourself National ld. Mr. Mrs. Ms. Nationalit Your Full Nae (as in passport/id) Date of Birth Passport. Marital Status Banglaeshi Expir Date Single Eucational Qualification Marrie Is spouse eploe? Post Grauate Favorite color: Grauate Favorite cit: HSC n Banglaeshi. of epenents Nuber of cars: Father's Nae Mother's Nae Spouse Nae Your nae as ou woul like it to appear on the Car (leave one space between naes, o not use title or nick nae) How o ou want to receive the car? Activation Passwor Through courier Fro CBL branch. If fro branch, please write the nae of the branch (Miniu 6 igit alphanueric - Please reeber this for car activation)
About our resience Your Resiential Status Owne Copan provie Rente Resiential Aress Cit Post Coe. of ears at current aress Year Month Your contact etails (tel/fax/eail) Office Phone. Ext.. Fax Resience Phone. Mobile/Pager E-ail Your Peranent Aress Reference etails 1st Reference Reference Nae Occupation 2n Reference Reference Nae Relation with applicant Occupation Present contact Aress Relation with applicant Present contact Aress Res. Phone Mobile. Res. Phone Office Nae & Aress Mobile. Office Nae & Aress Office Phone. E-ail ID Office Phone. E-ail ID About our work You are Salarie Self-eploe Both Stuent Copan Nae Retire If other (Please specif) Nature of Business Designation Departent Eploee ID. Office aress Cit Post coe Business establishent ate (if self eploe) Phone. of onths with current organization Nae of previous organization Total work experience in onths About our incoe If ou are salarie: Basic (onthl) Tk. Allowances (onthl) Tk. Total (onthl) Tk. If ou are self-eploe: Gross incoe (onthl) Tk. Expenses (onthl) Tk. Aitional onthl incoe (if an, attach relevant ocuents) : Incoe of spouse Tk. Net incoe Tk. Source of other incoe s' incoe Tk. TIN Stateent ailing aress (select an one) E - Stateents: Your onthl stateents will be sent in the for of e-stateents: (provie e-ail aress) For printe stateent (select an one): 1. Office aress 2. Resience aress About our bank loan accounts Bank nae & branch 1. 2. 3. Account. A/C tpe Installent aount (in taka) Outstaning aount (in taka)
Details of other creit cars Bank nae Car nuber Creit liit Meber since 1. 2. 3. Following section (SI) is onl for CBL account holer Staning instruction facilit (SI), I woul like to have Cit Bank's account autoaticall ebite each onth for paent of Creit Car ues as follows: *Monthl paent: Miniu aount ue 100% of current balance Cit Bank Account.1 for Account. 2 for Branch nae Signature te * If this is left blank, our account will be ebite for the iniu aount ue Suppleentar Car 1 Application (Enjo two Coplientar Suppleentar Car)* Mr. Mrs. Ms. Nae of Suppleentar Car applicant: First nae Mile nae Last nae Nae of Suppleentar Car applicant as ou woul like it to appear on the car (leave one space between naes an o not use title or nicknae) Relationship with the Priar Car applicant Date of Birth Spouse Parent Brother/Sister Chil (please specif)... Occupation Father's nae Mother's nae Aress Woul ou like to set up a spening liit per billing ccle to our Suppleentar Car? If es % of local Creit liit an % of Creit liit Car. TIN Mobile. Eail ID Suppleentar Car 2 Application Mr. Mrs. Ms. Nae of Suppleentar Car applicant: First nae Mile nae Last nae Nae of Suppleentar Car applicant as ou woul like it to appear on the car (leave one space between naes an o not use title or nicknae) Relationship with the Priar Car applicant Date of Birth Spouse Parent Brother/Sister Chil (please specif)... Occupation Father's nae Mother's nae * For Cit Bank Aerican Express Platinu Creit Car, Two (2) Suppleentar Cars are coplientar an for Cit Bank Aerican Express Creit Car an Cit Bank Aerican Express Gol Creit Car, One (1) Suppleentar Car is coplientar.
Suppleentar Car 2 Application (cont.) Aress Woul ou like to set up a spening liit per billing ccle to our Suppleentar Car? If es % of local Creit liit an Car. Mobile. % of Creit liit TIN Eail ID Photo Priar Car Applicant Suppleentar Car 1 Applicant Suppleentar Car 2 Applicant Please attach 2 recent color passport size photographs in this box, write our nae on the back of the photographs. Please attach 2 recent color passport size photographs in this box, write our nae on the back of the photographs. Please attach 2 recent color passport size photographs in this box, write our nae on the back of the photographs. Signatures Sign within area, use black ink onl Priar Car Applicant's Signature Suppleentar Car 1 Applicant's Signature Suppleentar Car 2 Applicant's Signature Suppleentar Car Applicant Declaration I, the Suppleentar Car applicant, agree to be jointl an separatel liable to all transactions processe b the use of the Car applie for an issue b CBL to the Priar Car applicant an/or to self, an to be boun b all the ters an conitions of the Bank's Creit Car Agreeent. Signature Suppleentar Applicant 1 Signature Suppleentar Applicant 2 Date (//) Priar Car Applicant Declaration I hereb appl for an Aerican Express Creit Car & eclare that the inforation provie in this application is true an correct an I shall avise ou of an changes thereto. I hereb authorize The Cit Bank Liite to verif an inforation fro whatever sources it a consier appropriate. I accept that The Cit Bank Liite is entitle in its absolute iscretion to accept or reject this application without assigning an reason whatsoever an that the application an its supporting ocuents shall becoe part of the Bank's recors an shall not be returne to e. I acknowlege an agree that the use of the Priar Car an/or Suppleentar Car(s) if an, issue on account shall be eee as an acceptance of the ters an conitions of the Bank's Creit Car Agreeent (which a be aene fro tie to tie) accopaning the Car. Upon approval I agree to pa the prevailing fees. B signing the application an/or activating an/or using the Car, I agree to be boun b the ters an conitions as entione in the Bank's CITY BANK AMERICAN EXPRESS CREDIT CARD agreeent. Where requeste, I authorize The Cit Bank Liite to issue Suppleentar Car(s) for use on account to the person(s) nae who I unertake is over 18 ears of age, an is a resient of Banglaesh an agree that ou a provie inforation to hi/her about the account. In case the Suppleentar Car Applicant is between 18 an 21 ears ol, I hereb unertake that the use of such Car shall be ae uner supervision an control. I hereb agree to inenif the Bank against loss, aage, liabilit or cost incurre b the Bank on account of an breach b e or b the Suppleentar Careber(s) of the aforesai Conitions or an other Ters an Conitions containe in the Bank's CITY BANK AMERICAN EXPRESS CREDIT CARD Agreeent or b reason of an legal isabilit or incapacit of the suppleentar Careber. I also unerstan that the Suppleentar Car fees shall be bille in stateent an it shall be priar responsibilit to honor all charges incurre on the Suppleentar Car. The continuation of the ebership of the suppleentar Careber(s) shall be epenent on the continuation of ebership.
I a also aware that Cit Shiel Insurance Coverage is available for e - being the Priar Careber - with the CITY BANK AMERICAN EXPRESS CREDIT CARD. I have unerstoo the Ters, Conitions, Exclusions an Benefits of this valuable Protection Schee. Being age between 18 an 60, I agree, unless I state in writing to The Cit Bank Liite otherwise, to get enrolle into Cit Shiel Insurance progra autoaticall upon opening of Creit Car account an I unerstan that this insurance is not applicable to the consequences of a sickness or an accient incurre prior to enrolent in the Insurance Schee. I hereb authorize the insurance copan to verif the inforation in relation with this insurance schee fro whatever sources it a consier appropriate. I hereb agree that all stateents whether through e-stateents service or other eans of transission sent b the, Bank for CITY BANK AMERICAN EXPRESS CREDIT CARD shall be accepte an uphel b e as correct an authentic. I eclare that I shall not raise an objection against the Bank on its agreeing to the sae an I full accept the risk an responsibilit of stateents transitte b the Bank. The Bank oes not warrant against an external factors affecting the privac an/or securit of e-ail uring internet transission. I also agree to keep the Bank inenifie against all actions, proceeings, liabilities an clais, cases, aages, costs an expenses in relation to or arising out of so accepting request b the Bank an transitting stateents an inforation through e-ail. I assure the Bank that I shall infor in writing of an change in e-ail aress or an request for iscontinuation of this facilit to Cars Departent, The Cit Bank Liite, AI-Ain Centre (8th Floor), 25/A, Dilkusha CIA, Dhaka-1000. The Bank shall not be liable or responsible for ata corruption, ela an/or interception of the inforation so given an the Bank reserves the right to upate ever such inforation fro tie to tie an at an tie. I hereb inenif the bank that I shall notif the bank at least one onth before renewal of car or iscontinuation of the sae. Priar Car Applicant's Signature Date (//) For Bank use onl Application. Date Car. Creit Liit (in Taka) Please te: You o not have to be a Cit Bank Account holer to appl for an Aerican Express Creit Car Enclose the following ocuents: a) Photograph (2 copies) b) Cop of Passport (First 5 pages an last 3 pages if ou appl for a ual car) c) Personal Bank Stateent for last 6 onths for businessan & 3 onths for salarie person ) If salarie, latest original salar certificate/pa slip e) If self-eploe, cop of Trae License/Meoranu/Articles of Association an Personal/Copan Bank Stateent for the last 6 onths f) Cop of TIN (Tax Ientification Nuber) relate ocuents g) Cop of NID (National Ientit Car) {an Photo ID when NID is not available} Coplete all sections of the application for. Incoplete application a be elae or cancelle CUSTOMER DECLARATION I a aware of all fees an charges applicable to the Cit Bank Liite's AMERICAN EXPRESS CREDIT CARD I a aware that the Bank reserves the right to revise/ipose fees an charges fro tie to tie I a aware of the CITY BANK AMERICAN EXPRESS CREDIT CARD's onthl paent requireents I a aware that the Bank a seek to verif or confir the valiit of inforation I have fille up the application for self I have applie for CITY BANK AMERICAN EXPRESS CREDIT CARD without an unue influence I have furnishe all supporting ocuents along with the application for I a aware that The Cit Bank Liite has the right to reject application without assigning an reason I a aware that the assigning of creit liit is at the sole iscretion of the Bank I a aware of all benefits an uses of CITY BANK AMERICAN EXPRESS CREDIT CARD Docuents Subitte Photo Salar Certificate/Paslip Bank Stateent Trae License TIN Certificate Meoranu/Articles of Association Cop of Passport National ID s... (Please specif) I,, have rea an unerstoo the above stateents an also confir that the above eclaration provie b e in this for is true an correct I also confir that Mr./Ms. Signature (Cars Division Official), has explaine to e all the features of The Cit Bank Liite's AMERICAN EXPRESS CREDIT CARD Date (//)
CREDIT CARD BALANCE TRANSFER FORM Cit Bank Aerican Express Creit Car Inforation Aerican Express Creit Car nuber Creit Liit Expir ate Expir ate Expir ate Careber's nae Creit Car 1 Bank nae Creit Car nuber Creit Liit Aount to be transferre (iniu 10,000) Creit Car 2 Bank Nae Creit Car nuber Creit Liit Total aount to be transferre Aount to be transferre (iniu 10,000) Please attach: 1. Cop of the other bank's Creit Car(s) front an back sie 2. Copies of the last 3 onths' of other bank Car(s) stateents Declaration & Signature I hereb appl for CBL Balance Transfer facilit which states that, I can transfer an outstaning aount (ore than 10,000 an less then 90% of total creit liit) fro an of existing other Bank's creit car(s) to CITY BANK AMERICAN EXPRESS CREDIT CARD. I eclare that the inforation in this application for is true an correct. I also eclare that the ocuents subitte with this application are genuine an I shall infor the Bank of an changes thereafter. I hereb authorize CBL to verif an inforation fro whatever sources it a consier appropriate. I accept that CBL is entitle at its absolute iscretion to accept or reject this application without assigning an reason whatsoever an that the application an its supporting ocuents shall becoe part of the Bank's recors an shall not be returne to e. I hereb affir that I will pa all the installents of the approve aount within correct tie frae an I will accept whichever aount is approve b the Bank. I also affir that if I fail to pa an installent it will be ae to current outstaning aount an regular rate of interest will be calculate. I acknowlege an agree that upon approval of a Balance Transfer, processing fee will be charge an shall be bille in stateent an I a well aware of other fees & charges. I irrevocabl authorize an perit the Bank to isclose an furnish such inforation that it ees fit concerning Balance Transfer incluing but not liite to this agreeent to the Bank's associates, branches, assignees, agents or other parties. I also irrevocabl authorize an perit the Bank to isclose inforation about creit car account (if an) to an creit rating/reference agenc, bank, financial institute, an Governent regulator agenc or to anone else when the Bank ees it is in its interest to o so., I woul like to take the facilit of CITY BANK AMERICAN EXPRESS CREDIT CARD Balance Transfer progra. The ters & conitions of this progra are full unerstoo b e. Signature Date Instruction Processe b Date Instruction Checke b Date For Bank Use Onl Balance Transfer will be subject to the satisfaction of the creit analst base on the support of the incoe ocuents an Careber's transaction behavior.
Ters & Conitions for Balance Transfer 1. Balance Transfer (BT) features offer Aerican Express Carebers a special interest rate, applicable onl on the outstaning balance transferre fro other Banks' creit car(s). 2. The special interest rate is vali until the entire transferre aount is pai off. 3. Interest rate 22% per annu. 4. A processing fee @ 1% of the total transferre aount will be charge to the account. 5. To qualif as a BT applicant, ou ust not have pai ore than 1 (one) Late Paent Fees in our other Bank's creit car(s) uring the last 3 onths' perio. 6. A Careber can appl for one BT in 1 ear. 7. To avail the BT facilit, ou ust enclose copies of our other Banks' creit car(s) stateent for the last 3 onths. 8. The iniu that can be transferre fro an other Banks' creit car account to our Cit Bank Aerican Express Creit Car is Tk.10,000. 9. The axiu aount that can be transferre fro an other Banks' creit car account to our Cit Bank Aerican Express Creit Car is 90% of the available local currenc creit liit on our Cit Bank Aerican Express Creit Car as on the ate of approval of our application. You can transfer balances fro ore than one Bank's Creit Car uner the sae within this liit. 10. If the aount (as entione in the application for) to be transferre to our Cit Bank Aerican Express Creit Car excees 90% of the available creit liit on the ate of acceptance b CBL, CBL will autoaticall transfer onl an aount equal to 90% of our creit liit available at that tie. 11. CBL shall eposit the pa orer favoring the other creit car account for the approve transfer aount irectl to the car issuer an sen ou the cop of the eposit slip for reference. 12. Cit Bank Aerican Express Creit Carebers a request for transfer fro ultiple car accounts. Careber has to request for all such BT at the sae tie (which eans ultiple car transfer at the sae tie. It cannot be staggere). 13. During the BT ter, the balance transferre will also be inclue for coputing the iniu paent ue, as entione in our Creit Car stateent fro CBL. 14. CBL reserves the right to ecline an BT request. 15. CBL shall not be hel liable for the service charges or late paent charges ebite to other Bank's creit car account ue to ecline or ela in execution of our BT request. 16. You shall continue to ake paents on our other Banks' creit car until ou receive confiration in a subsequent Cit Bank Aerican Express Creit Car stateent that our account with the other issuer(s) has been creite. 17. This facilit cannot be availe to transfer balance fro another Cit Bank Aerican Express Creit Car. 18. CBL has the sole right to oif or change an of the above ters an conitions without prior notice. 19. The entire BT outstaning on the creit car (incluing an balances transferre) will becoe paable ieiatel upon closure of the creit car whether such closure is initiate b the Bank or b the Careber. Insurance Declaration in Car Application Priar Car Applicant's Declaration I a aware that Cit Shiel Insurance Coverage is available for e - being the Priar Careber - with the Cit Bank Aerican Express Creit Car. I have unerstoo the Ters, Conitions, Exclusions an Benefits of this valuable Insurance Schee. Being age between 18 an 60, I agree, unless I state in writing to The Cit Bank Liite otherwise, to get enrolle into Cit Shiel Insurance progra autoaticall upon opening of Creit Car account an I unerstan that this insurance is not applicable to the consequences of a sickness or of an accient incurre prior to enrolent in the Insurance Schee an if Car account becoes overue for 02 (two) onths. I hereb authorize the insurance copan to verif the inforation in relation with this insurance schee fro whatever sources it a consier appropriate. Priar Car Applicant's Signature Date (//) Cit Shiel Insurance Coverage I/we, hereb assign the benefits of Cit Shiel Insurance tonae of Beneficiar (ies) an Percentage Share of Benefits Priar Car Applicant s Signature 1. Benefit % Relation: 2. Benefit % Relation: 3. Benefit % Relation: Date (//)
Priorit Pass Mebership Car Replaceent Fee Less than 50,000. N/A N/A Nill 50,000 to less than 500,000. 10.00 500,000 an above - ral Clearing. 25.00 500,000 an above - Sae Da Clearing 60.00 N/A 1000