UWI VISA Credit Card Application - FirstCaribbean International Bank

UWI VISA Credit Card ApplicationI am applying as: ALUMNI STAFF STUDENTWhat card are you applying for: CLASSIC GOLD PLATINUMPlease remember to include the following with your application: your signature, a copy of your photo ID , e.g. Driverslicense or National Registration, a job letter, a recent pay slip (copies of the last six (6) months’ Bank statements) anda copy of a utility bill for address verification. Self-employed persons should include the aforementioned plus financialstatements for the past year and a copy of your company registration certificate.ABOUT YOURSELFPlease type in BLOCK CAPITALS and tick where necessaryMale Female TitleFirst Name Initial Surname Date of BirthD M YSingle Married Windowed Separated DivorcedNumber of dependentsHome AddressPrevious address (if less than 2 years at present address)Nationality National Registration NumberMailing AddressTelephone (H)Sole OwnerHouse and landRentingfurnishedCell (C)EmailNext of Kin/ReferenceRelationshipTelephoneJoint OwnerRentingHouse and land unfurnishedOwner Living withhouse onlyparentsOwnerland onlyHome Address

UWI VISA Credit Card ApplicationEMPLOYMENT DETAILSRetiredSelf-Employed(If self-employed, please specify the name and nature of the business)Employer’s NameEmployer’s AddressYears there Position TelephonePrevious Employer’s Name (if at current employer for less than 2 years)Years there PositionFINANCIAL DETAILSYou need not include spouse’s income, alimony, child support or maintenance payments made to you if youare not relying on them to establish creditworthiness.Gross monthly salary $ Rent/ Mortgage $Spouse’s monthly salary $ Hire purchase $Other Income & Details $ Other loans $$ Food/Clothing $$ Other Utilities $(water, elec. etc.)INCOME TOTAL $ Vehicle Expenses $Less Expenses total $ Other Commitments $(NIS, PAYE, Ins, etc.)Surplus $ EXPENSES TOTAL $Name of your bankBranchAccounts heldChequing Deposit Savings Loan OtherYears there

UWI VISA Credit Card ApplicationOTHER FINANCIAL INSTITUTIONSAccounts held Chequing Deposit Savings Loan OtherWHAT CARDS DO YOU HOLDName of Card Issuer MasterCard VISA AMEXOther (please specify)Any prior or present court judgments against you? Yes NoADDITIONAL CARDHOLDER Would you like an additional card for a member of your family or household?Additional Cardholder’s First Name Initial SurnameNationalityNational Registration NumberSignature of additional cardholder_____________________________________________________

UWI VISA Credit Card ApplicationFIRSTCARIBBEAN GUARANTEEPlease note: if you are a full-time student without regular income, you must complete this guarantor form.Please include the guarantor's proof of ID, a job letter and proof of address with your application.To: First Caribbean International Bank (insert country) ((insert branch)) Limited ofIn consideration of your having at our request agreed to advance to (insert applicant's name)of (insert applicant's address)a co-branded UWI VISA Credit Card the limit of which may not exceed at any time US$500, we the undersignedhereby guarantee to you the repayment by the said (insert applicant's name)of all sums incurred by him/her in the use of the said Credit Card, such sum and all interests due thereonnot to exceed the limit aforesaid subject as hereinafter mentioned, that is to say:1. Notice in writing of any default on the part of the said ( insert applicant's name)is to be given by you to us within 30 days from its receiptpayment shall be made by us of all sums then due from us under this guarantee.2. This guarantee is a continuing guarantee within the limits aforesaid.3. No change in the constitution of FirstCaribbean International Bank shall affect orimpair our liability hereunder, whether past present or future.4. This guarantee is a guarantee of all sums up to and including the said maximum limitincurred by the said (insert applicant' name)to you and ourliability hereunder shall under no circumstances exceed in the aggregate the sum of US$5505. In the event that the cardholder becomes disassociated with the guarantor, the guarantorshall immediately serve notice of that fact upon FirstCaribbean, proceed to extinguish alloutstanding liabilities in connection with the Credit Card and exercise a power of withdrawalfrom all liability hereunder.Dates this day of 200 For and on behalf of:Name of Guarantor

UWI VISA Credit Card ApplicationFIRSTCARIBBEAN INTERNATIONAL BANK CREDIT CARD SECURITY INSURANCE (OPTIONAL)Would you like to insure your FirstCaribbean Credit Card balance? Yes NoI understand that to be eligible for coverage I must be at least 18 years of age and under 70 to enroll; andthat my coverage will be bound by the terms and conditions stated in my Certificate of Insurance.Furthermore I authorize the Bank to provide the insurer with my FirstCaribbean Credit Card accountnumber, monthly statement balance and any other necessary information; and I authorize the insurerto charge monthly premiums to my FirstCaribbean Credit Card account._________________________________Applicant Consent_________________________________Applicant Waiver of InsuranceCredit Limit Requested $FOR BANK USE ONLYGood bank report Yes NoPending Cards ReferenceApproved Limit $ DateCIF #Card #