GPC onecard
Cardholder Application Form
When filling out this form by hand, please complete in BLOCK CAPITALS and in black ink. When filling out this
form on screen, please use the tab key to move between the relevant fields. Ensure you do not use the return or
enter keys.
p Your information
For details of how we will use your information and how to give your consent, please look for the padlock symbol below
and in the accompanying Terms and Conditions (please see section 5 for relevant cardholder information).
All sections must be completed.
1. Business details
Company/Organisation name
Billing unit name
Billing unit number (if you have an existing Card account,
please insert your 16 digit account number as shown on your
Summary Statement)
Reporting unit name
2. Cardholder details
Title
Mr
X
Mrs
X
Miss
X
Ms
X
Other
X
If ‘Other’, please specify
First name
Middle name(s)
Surname
Name as you wish it to appear on the card
Name
e.g. title, first name, middle initial and surname (max. 21 characters incl. spaces)
Residential
address
Address line 2
Address line 3
Address line 4
Postcode
Country of Residence
E-mail address
Security password
Date of birth
(DDMMYYYY)
Nationality
RBS GPC o 06/12
90195638
Page 1 of 5
90195638.indd 1
26/06/2012 10:54
Correspondence address
(only required where cards or statements are being mailed to you direct)
If correspondence address is same as residential address, tick box.
Or complete details below.
Address line 1
Address line 2
Address line 3
Address line 4
Postcode
p Keeping you informed
We would like to keep you informed by letter, phone and electronic means (including e-mail and mobile messaging)
about products, services and additional benefits that we believe may be of interest to you.
If you don’t want us to do this, please place a cross in this box. X
p Giving your consent
By signing below you are agreeing that we may use your information in the way described in this form including the
“Keeping you informed” section and in the associated Terms and Conditions (please see section 5 for relevant
cardholder information).
Cardholder’s signature
Date
If individually billed has been selected by the company/organisation, please complete.
(Individual billing is only available to residents of the UK, Channel Islands, Isle of Man and Gibraltar)
Payment method:
Please complete Direct Debit mandate (back page)
•DirectDebit
•Ifyoupreferadifferentpaymentmethodpleasecontact0870 909 3702 for more details and state your payment
method here:
3. Cardholder details to be specified by the company/organisation
Please mark if you require the following*:
Standard Card
X
Gold Card
Is a single transaction limit
required for authorisation purposes?
Monthly credit limit required £
(This should equal one month’s
anticipated spend)
Yes
X
X
No X
£ £ , £ £ £, £ £ £
Cash withdrawal facility**
If ‘Yes’, how much? £
X
£ £ , £ £ £, £ £ £
Convenience cheques X
Cardholder reference number
(for identification of your cardholder on reports)
* Charges may apply, please refer to your agreed pricing.
**Please mark if you require a cash withdrawal facility i.e. ATM cash, cash and foreign currency over a branch
counter and travellers’ cheques (if left blank your cardholder will NOT be authorised to undertake any form of
cash transaction).
RBS GPC o 06/12
90195638
Page 2 of 5
90195638.indd 2
26/06/2012 10:54
4. Authorisation by the company/organisation
Please issue a RBS Card to the person named in section 2, who is authorised by the company/organisation
to undertake card transactions as defined in the card Terms and Conditions. The company/organisation agrees
that it will meet all expenditure and other charges and interest incurred through the use of the card or in respect
of transactions.
Signed in accordance with the Authorised Signatories as listed in the card programme Application Form.
Title
Mr
X
Mrs
X
Miss
X
Ms
X
Other
X
If ‘Other’, please specify
First name
Middle name(s)
Surname
Authorised signature(s)
Date
Title
Mr
X
Mrs
X
Miss
X
Ms
X
Other
X
If ‘Other’, please specify
First name
Middle name(s)
Surname
Authorised signature(s)
Date
5. Cardholder information
p Your information
Who we are
Your account is with The Royal Bank of Scotland plc.
We are a member of The Royal Bank of Scotland Group (the Group). For more information about our Group
of companies, please visit www.rbs.com and click on ‘About us’, or for similar enquiries please telephone
0131 556 8555 or Minicom 0845 900 5960*.
Your electronic information
If you contact us electronically, we may collect your electronic identifier (e.g. Internet Protocol (IP) address or
telephone number) supplied by your service provider.
How we use your information and who we share it with
Your information includes information about you and your transactions.
We may use and share your information with other members of the Group to help us and them:
• preventanddetectcrime;
• understandourcustomers’requirements;
• developandtestproductsandservices.
If you are financially liable for the company/organisation’s borrowing, we may also use and share your information
with other members of the Group to help us and them:
• assessfinancialandinsurancerisk;
• recover debt.
RBS GPC o 06/12
90195638
Page 3 of 5
90195638.indd 3
26/06/2012 10:54
We do not disclose your information to anyone outside the Group except:
• wherewehaveyourpermission;or
• wherewearerequiredorpermittedtodosobylaw;or
• toothercompanieswhoprovideaservicetousoryou;
• wherewemaytransferrightsandobligationsunderthisagreement.
We may transfer your information to other countries. If we do this we will ensure that anyone to whom we pass it
provides an adequate level of protection.
From time to time we may change the way we use your information. Where we believe you may not reasonably expect
such a change we shall write to you. If you do not object to the change within 60 days, you consent to that change.
If you would like a copy of the information we hold about you, please write to: The Royal Bank of Scotland plc,
Commercial Cards Division, Cards Customer Services, PO Box 5747, Southend-on-Sea SS1 9AJ.
A fee may be payable.
p Fraud prevention agencies
If false or inaccurate information is provided and fraud is identified or suspected, details may be passed
to fraud prevention agencies.
Law enforcement agencies may access and use this information.
We and other organisations may also access and use this information to prevent fraud and money laundering, for
example when:
• checkingapplicationsfor,andmanagingcreditorotherfacilitiesandrecoveringdebt;
• checkinginsuranceproposalsandclaims;
• checkingdetailsofjobapplicantsandemployees.
We, and other organisations that may access and use information recorded by fraud prevention agencies, may do so
from other countries.
We can provide the names and addresses of the agencies we use if you would like a copy of your information held
by them. Please contact The Royal Bank of Scotland plc, Commercial Cards Division, Cards Customer Services,
PO Box 5747, Southend-on-Sea SS1 9AJ. The agencies may charge a fee.
*Calls may be recorded. Max call charge from a BT landline is 13.1p per minute plus up to 7.95p per minute. Business rates
and calls from other networks may vary (call charges correct on 01/05/2012).
RBS GPC o 06/12
90195638
Page 4 of 5
90195638.indd 4
The Royal Bank of Scotland plc. Registered in Scotland No. SC90312.
Registered Office: 36 St. Andrew Square, Edinburgh EH2 2YB.
Authorised and regulated by the Financial Services Authority. No. 121882.
26/06/2012 10:54
Please fill in the whole form using a ball point
pen and send it to:
The Royal Bank of Scotland plc
Commercial Cards Division
Cards Customer Services
PO Box 5747
Southend-on-Sea
SS1 9AJ
Instruction to your
Bank or Building Society
to pay by Direct Debit
Service user number
9 1 4 6 2 3
FOR THE ROYAL BANK OF SCOTLAND PLC OFFICIAL USE ONLY
This is not part of the instruction to your bank or building society.
Name(s) of Account Holder(s)
We will use your card number/billing number as your reference
Bank/Building Society account number
Branch Sort Code
Name and full address of your Bank or Building Society
To: The Manager
Bank/Building Society
Instruction to your Bank or Building Society
Please pay The Royal Bank of Scotland plc Direct Debits
from the account detailed in this instruction subject to the
safeguards assured by the Direct Debit Guarantee. I understand
that this Instruction may remain with The Royal Bank of
Scotland plc, and if so, details will be passed electronically to
my bank/building society.
Signature(s)
Address
Postcode
Date
Reference
Banks and building societies may not accept Direct Debit Instructions from some types of account
This guarantee should be detached and retained by the payer
The Direct Debit Guarantee
•ThisGuaranteeisofferedbyallbanksandbuildingsocietiesthatacceptinstructionstopayDirectDebits.
•If there are any changes to the amount, date or frequency of your Direct Debit The Royal Bank of Scotland plc
will notify you 3 working days in advance of your account being debited or as otherwise agreed. If you request
The Royal Bank of Scotland plc to collect a payment, confirmation of the amount and date will be given to
you at the time of the request.
•If an error is made in the payment of your Direct Debit by The Royal Bank of Scotland plc or your bank or
building society you are entitled to a full and immediate refund of the amount paid from your bank or
building society.
•If you receive a refund you are not entitled to, you must pay it back when The Royal Bank of Scotland plc
asks you to.
•You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written
confirmation may be required. Please also notify us.
RBS GPC o 06/12
Page 5 of 5
90195638.indd 5
26/06/2012 10:54