Additional Card Application Form
SECTION 2 – NEW ADDITIONAL CARDHOLDER DETAILS
SECTION 1 – PRIMARY CARDHOLDER’S DETAILS
Card Number (if known)
Card Number (if known)
Card Number (if known)
Title
Title
Title
First Name
Middle Name
Surname
Date of birth
/
Nationality
First Name
Middle Name
Mother’s maiden name
Surname
Date of birth
/
/
Occupation
Mother’s maiden name
Occupation
Suburb/Town
Mobile
Postcode
Postcode
)
Mobile telephone number
Email address
I understand that: I authorise the fulfilment of the attached request(s) to set
up the nominated people specified in Section 2. There is an annual fee of:
- $19 for each Citi Cash Back Additional Card
- $19 for each Citi Clear Additional Card
- $0 for each Citi Clear Platinum Additional Card
- $0 for each Citi Simplicity Additional Card
- $30 for each Citi Gold Additional Card
- $15 for each Citi Classic Additional Card
- $90 for each Citi Rewards Platinum Additional Card
- $0 for each Citi Rewards Signature Additional Card
- $0 for each Citi Prestige Additional Card
- $0 for each Emirates Citi World Mastercard® Additional Card
which will be charged pro-rata upon card issuance and annually with the Primary
Cardholder Annual Fee. The Primary Cardholder is responsible for all debts incurred
by the Additional Cardholder(s).
Additional Cards cannot be issued to individuals under 16 years of age. The Card
may be cancelled at any time by phoning Citibank. Upon approval of your Credit
Card we will notify you of how to meet “Citibank’s Customer Identification
Requirements” as required by the AML/CTF Act 2006 and other Federal legislation.
Citigroup Pty Limited ABN 88 004 325 080, AFSL 238098, Australian Credit
Licence 238098 is the credit provider and issuer of these credit cards.
Signature
First Name
Surname
Date of birth
/
Nationality
Date
/
/
Mother’s maiden name
First Name
Surname
Date of birth
/
Occupation
Suburb/Town
7
Card Number (if known)
/
Mother’s maiden name
/
Nationality
State
Email address
Additional Cardholder’s Signature*
7
7
Middle Name
Residential Address (PO Box not acceptable)
Number
Street
Mobile
Email address
Title
Middle Name
Postcode
Additional Cardholder’s Signature*
7
Title
State
Mobile
Card Number (if known)
Suburb/Town
FOLD HERE
(
State
Occupation
Residential Address (PO Box not acceptable)
Number
Street
Additional Cardholder’s Signature*
Home telephone number
Mother’s maiden name
/
Nationality
Residential Address (PO Box not acceptable)
Number
Street
Suburb/Town
Surname
Date of birth
/
Residential Address (PO Box not acceptable)
Has your address changed recently?
Call CitiPhone banking on 13 24 84 and we’ll update our records.
Number
Street
State
Middle Name
/
Nationality
First Name
Occupation
Residential Address (PO Box not acceptable)
Number
Street
Postcode
Suburb/Town
Mobile
State
Postcode
Email address
Additional Cardholder’s Signature*
7
* By signing this I confirm that I have read and agree to the terms of the Privacy Consent overleaf.
Instructions: 1. Complete 2. Fax to 1300 301 304 or mail to Citigroup Pty Limited, Reply Paid 1625, Sydney NSW 2001
MCG13188_(0416)
Privacy Consents and Notifications
By requesting this product, you consent as follows:
In this section ‘we/us’ means Citigroup Pty Limited and our related companies that assist us to provide our services and ‘you/your’ means all card holders.
Purposes for which we collect, use and disclose your personal information
1) We collect, use and disclose your personal information:
•to administer the account and related services;
•to comply with applicable laws both in Australia and overseas, including:
a) the National Consumer Credit Protection Act;
b) the Anti-Money Laundering and Counter-Terrorism Financing Act;
c) State and Territory property legislation and other property-related laws (for example, to register and search for security interests); and
•for other purposes as listed in our Privacy Policy.
If you do not provide us with the information we may not be able to assess your request or administer the products or services that you are seeking.
2) We usually collect your personal information directly from the Primary Cardholder or you. However, we may need to collect personal information about you from third parties for example, in order to assist us
to process your request or to communicate with you.
3) Where you have provided information about another individual, you must make them aware of that fact and the contents of this Privacy Consent and Notification, and have obtained their consent to make this
disclosure to us.
4) Your telephone calls and conversations with our representative may be recorded and monitored for quality, training and verification purposes.
Disclosures of your personal information
5) We may disclose to, and obtain personal information about you from:
•Our affiliates, sales agents and organisations that carry out functions on our behalf including card schemes, mailing houses, data processors and collection agents;
•reward providers including Airline partners and their service providers;
•any broker, introducer, financial, legal or other adviser acting in connection with your facility or application;
•regulatory and tax authorities in Australia and overseas;
•any insurer relating to your facility;
•organisations wishing to acquire an interest in any part of our business; and
•as further set out in our Privacy Policy.
Disclosures to overseas recipients
6) Some of the recipients to whom we disclose your personal information may be based overseas. It is not practicable to list every country in which such recipients are located but it is likely that such countries
will include the United States of America, India, the Philippines, Malaysia, Hong Kong and Singapore. By consenting to us disclosing your personal information to overseas recipients, you agree that Australian
Privacy Principle 8.1 shall not apply to the disclosure, meaning that Citibank will not be obliged under the Privacy Act to ensure that an overseas recipient does not breach the Australian Privacy Principles and
we will not be liable under the Privacy Act if the recipient does not act consistently with the Australian Privacy Principles. By submitting this request you consent to such overseas disclosures.
Our Policies (including how to access and correct information and make a complaint)
7) You can view our Privacy Policy on our website at citibank.com.au/privacy or obtain copies by calling us. This policy includes information as to how you can access and/or seek correction of the personal
information we hold about you. Our Privacy Policy also contain information as to how you can complain about a breach by us of the Privacy Act (including the credit reporting provisions in Part IIIA and the
Credit Reporting Code) and how we will deal with such a complaint.
Your Marketing Communications Preferences
8) By completing this application you agree that we, our affiliate companies and their partners may use your personal information to keep you informed about offers relating to this product and other products,
services and offers which may be of interest to you. They may do this by phone, mail, email and SMS or other electronic messages (without an unsubscribe facility). These consents operate indefinitely and
shall remain in effect unless and until you notify us that you do not want to receive such communications. If you do not wish to receive these communications please notify us in writing or by calling us.
Note: If you have not told us that you do not wish to receive these communications by phone, you may be contacted even if you have registered your phone number on the national Do Not Call Register.