supplementary application form supplementary ... - American Express
supplementary application form supplementary ... - American Express
supplementary application form supplementary ... - American Express
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AMERICAN EXPRESS INTERNATIONAL CURRENCY CARDS<br />
List of professionals who can certify your Documentation:<br />
Accountant with a recognised professional qualification<br />
(eg chartered account)<br />
Bank Employee<br />
Registered Lawyer/Barrister/Solicitor<br />
Senior Civil Servant (Individual who has a permanent job<br />
with the Government)<br />
Commissioner of Oaths/Justice of the Peace<br />
Doctor<br />
Engineer with a recognised professional qualification<br />
Member of Parliament<br />
Police Officer<br />
Optician<br />
Post Office official<br />
Chartered Surveyor<br />
Dentist<br />
Example of a Certified Passport, Identity Card or Driving Licence:<br />
IDENTITY CARD<br />
FULL NAME: John Smith<br />
DATE OF BIRTH: 1 Jan 89<br />
NO: 2009-0101-1000-0202<br />
COUNTRY: UK<br />
A valid and true copy of<br />
Passport or Identity Card<br />
or Driving Licence<br />
This must show a<br />
photograph, full name, date<br />
of birth and Passport or<br />
Identity number<br />
I certify that this is a valid and true copy of the original<br />
document and is a true likeness of Mr. A Sample<br />
Application<br />
reference number: 2009-0101-1000-0202<br />
(applicable to online <strong>application</strong>s only)<br />
Original seen<br />
Full name of certifier:<br />
Business<br />
Address:<br />
Telephone number<br />
of certifier<br />
(including dial code):<br />
Signature:<br />
Profession:<br />
Date:<br />
✓<br />
CF Frost<br />
Sample Street<br />
Sample Town<br />
UK<br />
We accept a personal number (mobile or landline) or a<br />
business telephone number (general or direct)<br />
C Frost<br />
Lawyer<br />
01/01/2011<br />
Example of a Certified Proof of Address:<br />
Bank or<br />
Utility<br />
letterhead<br />
A bank statement or utility bill<br />
(on bank or utility letterhead)<br />
dated within the last 3 months<br />
which must have been sent<br />
through the postal service.<br />
I certify that this is a valid and true copy of the original document<br />
Application<br />
reference number: 2009-0101-1000-0202<br />
(applicable to online <strong>application</strong>s only)<br />
Original seen<br />
Full name of certifier:<br />
Business<br />
Address:<br />
Telephone number<br />
of certifier<br />
(including dial code):<br />
Signature:<br />
Profession:<br />
Date:<br />
✓<br />
CF Frost<br />
Sample Street<br />
Sample Town<br />
UK<br />
We accept a personal number (mobile or landline) or a<br />
business telephone number (general or direct)<br />
C Frost<br />
Lawyer<br />
01/01/2011<br />
Please note, we require the certifier to provide their telephone number.<br />
We accept a personal number (mobile or landline) or a business telephone number (general or direct).<br />
<strong>American</strong> <strong>Express</strong> Services Europe Limited<br />
Registered Office: Belgrave House, 76 Buckingham Palace Road, London, SW1W 9AX, United Kingdom<br />
Registered in England and Wales with Company Number 1833139.<br />
<strong>American</strong> <strong>Express</strong> Services Europe Limited is authorised by the Financial Services Authority under the Payment Services<br />
Regulations 2009 415532 for the provision of payment services.