INTERNATIONAL VISA CREDIT CARD APPLICATION     Download & Print Printer Friendly Version

Which International Card Are You Applying For?   Visa Classic Visa Gold   Prefered Branch:

1. Please Tell us about yourself (Principal Applicant)
Surname* First & Middle Initial *
Mr. Ms Mrs
TRN:*
 Mother's maiden name*
Birthdate*

date format dd/mm/yyyy
Marital Status*  Single Divorced Widowed
Married Separated
No. of Dependants* ID Type & No:*

Present home address* No. Of Years
 
Mailing Statement Address (if different)
 Home telephone #*
Previous home address (if at present less than 3 years) No. Of Years
Email Address*
 * Rent  Own  Family 
Other
Name and Address of nearest relative not living with you:*
Home Telephone No.*

2. Please Tell Us About your Job
Employer's Name {Job letter or state occupation if self employed required} No. of Years
 
Position
 Gross Monthly Salary $
Employer's Address
  		Business Telephone No.
 Other Monthly Earnings $
Previous Employer's Name and Address (if less than 3 years) No. Of Years
 
Source of Other Monthly Earnings
Total Gross Monthly Earnings $*

3. Please tell us about your co-applicant or additional cardholder (If you are applying for a joint credit card)
Mr. Ms Mrs TRN
Surname
 First & Middle Initial
Birthdate

date format dd/mm/yyyy 		Home telephone #
Marital Status
Single Divorced Widowed Married Separated
No. Of Dependants
ID Type & No;

Present home address No. Of Years
Mailing Statement Address (if different)  
Previous home address (if at present less than 3 years) No. Of Years
   
Email Address
Rent Own Family Other
Employer's Name {Job letter or state occupation if self employed required} Position
No. of Years

Employer's Business Tel No.
Employer's Address
Gross Monthly Salary $
Previous Employer's Name and Address (if less than 3 years) No. Of Years
Other Monthly Earnings $
Name and Address of nearest relative not living with you: Home Tel. No.
Source of Other Monthly Earnings
Total Gross Monthly Earnings $

4. Financial Information ( "A" - Principal Applicant, "B" - Co-applicant )
Assets
Value
Liabilities
Balance Outstanding
Monthly Payments
  A B   A B A B
Fixed Deposits     Bank Overdrafts      
Bank Accounts     Bank Loans      
Credit Union Shares     Credit Cards      
Unit Trust     Credit Union Loans      
Life Insurance CSV     Hire Purchase      
Other Liquid Assets     Monthly Rent/Mortgage      
Properties/Real Estate (Address)     Utility Bills (Electricity, Water, Telephone)      
      Car / Gas      
Vehicles     Misc      
      Sub-Total      
Other (Specify) i.e. Furniture/Appliance     Net Worth      
               
Total Assets* Total Liabilities*
A Main Bankers Branch B Main Bankers Branch  
Chequing A/C No.
F/Dep. Chequing A/C No.
F/Dep.
Savings A/C No.
Other Savings A/C No.
Other
Note: Current Total monthly repayments should not exceed 40% of gross monthly earnings.

 * I ACCEPT THE CONDITIONS OF USE (CLICK HERE TO READ)

I/We certify that the information I/we provided on this application is correct and complete. You may, from time to time, give any credit and other information about me/us, including any information on this Form to and receive such information from, any: (a) Credit Bureau or Reporting Agency; (b) Person with whom I may have or propose to have financial dealings; (c) First Global Bank Limited and its subsidiaries or affiliates; and (d) Person in connection with any dealings I have or propose to have with you.

We undertake to immediately advise you in writing of any change in any form of identification including but not limited to change of names and addresses and agree to provide such documentation as may be relevant.

I/we agree that you may use that information to establish and maintain any relationship with you and to offer me any services from time to time as permitted by law.