CREDIT CARD APPLICATION FORM
Applying for a VISA
r
r
r
CLASSIC
SILVER
GOLD
(USD 100- 5.000)
(USD 5.000- 10.000)
(USD 5.000- 10.000)
PERSONAL INFORMATION
Last name:
Nationality:
Maiden name:
Marital status:
First name:
# of dependants / children:
Date of birth:
ID:
Place of birth:
ADDRESS INFORMATION
Address:
Home owner
Years/months at this address:
Tel. # (home):
Billing address:
Tel. # (mobile):
Rented
Living with relatives
Mailing address (for statements):
E-mail address:
EMPLOYMENT INFORMATION
Employment situation:
Self-employed
Name of employer:
Occupation:
# of years with this employer:
Tel # employer:
Employed
Retired
FINANCIAL INFORMATION
Account #:
Monthly: mortgage / rent:
Accountholder since (month/year):
Monthly: other loans:
Monthly: Net income:
Monthly: other liabilities:
Monthly: total monthly payments / liabilities:
INFORMATION ADDITIONAL CARDHOLDER
Last name:
Date and place of birth:
Maiden name:
ID:
First name:
Relationship to cardholder:
PREFERRED PAY BACK METHOD
The undersigned agrees to debiting his / her account (as stated above) in the following manner:
1. 100 % of the balance;
2. Minimum monthly payments (5 % of the balance; interest 1% monthly);
3. Fixed monthly payments USD . . . . . . monthly (interest 1 % monthly).
Unemployed
I prefer to pick up my credit card at the following branch:
r
r
r
r
Finabank Centrum Dr. S. Redmondstraat 59 PARAMARIBO
Finabank IBC Mr. J. Lachmonstraat 49 PARAMARIBO
Trustbank Dr. S. Redmondstraat 93 PARAMARIBO
Finabank Nickerie R.P. Bharosstraat 84 NIEUW NICKERIE
Signature
Date
FINABANK'S USE ONLY
Te verschaffen dekking:
cashdekking, bedrag groot : USD
r hypothecaire dekking
Details:
Application made by:
(bankemployé and branch)
(rekeningnummer:
)