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GBTI VISA GOLD - US$
GBTI VISA CLASSIC - US$
Print in the boxes below how you would like your name to appear on Card. Spell last name completely. Full name must not exceed 20 spaces.
Full name must not exceed 20 spaces*
Branch*BranchAnna ReginaBarticaCorrivertonDiamondLethemParikaProvidencePort KaitumaPort MourantRegentVreed-en-HoopWater StKingston
Reason for applying for GBTI VISA Credit Card*
Customer CIF
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First Name*
Middle Name
Surname*
No of Dependants*
Salutation *MrMsMrs
Marital Status *DivorcedMarriedSingleWidowed
Date of Birth (dd/mm/yy): *
Place of Birth Country*
Nationality*
National Identification No*
Date of issue
Passport No
Country*
Expiry Date
Drivers Licence No
Country
Tax Payers Identification No
Home Address*
Mailing Address (if different from home address)
No of years there
Type of Residence* FamilyOwnerParentsTenant
Other please state
Email address *
Confirm Email address *
Country Code *Country Code*Guyana + 592Afghanistan + 93Albania + 355Algeria + 213American Samoa + 1-684Andorra + 376Angola + 244Anguilla + 1-264Antarctica + 672Antigua and Barbuda 1-268Argentina + 54Armenia + 374Aruba + 297Australia + 61Austria + 43Azerbaijan + 994Bahamas + 1-242Bahrain + 973Bangladesh + 880Barbados + 1-246Belarus + 375Belgium + 32Belize + 501Benin + 229Bermuda + 1-441Bhutan + 975Bolivia + 591Bonaire + 599Bosnia and Herzegovina + 387Botswana + 267Brazil + 55British Indian Ocean Territory + 246British Virgin Islands + 1-284Brunei + 673Bulgaria + 359Burkina Faso + 226Burundi + 257Cambodia + 855Cameroon + 237Canada + 1Cape Verde + 238Cayman Islands + 1-345Central African Republic + 236Chad + 235Chile + 56China + 86Christmas Island + 61Cocos Islands + 61Colombia + 57Comoros + 269Cook Islands + 682Costa Rica + 506Croatia + 385Cuba + 53Curacao + 599Cyprus + 357Czech Republic + 420Democratic Republic of the Congo + 243Denmark + 45Djibouti + 253Dominica + 1-767Dominican Republic + 1-809East Timor + 670Ecuador + 593Egypt + 20El Salvador + 503Equatorial Guinea + 240Eritrea + 291Estonia + 372Ethiopia + 251Falkland Islands + 500Faroe Islands + 298Fiji + 679Finland + 358France + 33French Polynesia + 689Gabon + 241Gambia + 220Georgia + 995Germany + 49Ghana + 233Gibraltar + 350Greece + 30Greenland + 299Grenada + 1-473Guam + 1-671Guatemala + 502Guernsey + 44-1481Guinea + 224Guinea-Bissau + 245Guyana + 592Haiti + 509Honduras + 504Hong Kong + 852Hungary + 36Iceland + 354India + 91Indonesia + 62Iran + 98Iraq + 964Ireland + 353Isle of Man + 44-1624Israel + 972Italy + 39Ivory Coast + 225Jamaica + 1-876Japan + 81Jersey + 44-1534Jordan + 962Kazakhstan + 7Kenya + 254Kiribati + 686Kosovo + 383Kuwait + 965Kyrgyzstan + 996Laos + 856Latvia + 371Lebanon + 961Lesotho + 266Liberia + 231Libya + 218Liechtenstein + 423Lithuania + 370Luxembourg + 352Macau + 853Macedonia + 389Madagascar + 261Malawi + 265Malaysia + 60Maldives + 960Mali + 223Malta + 356Marshall Islands + 692Mauritania + 222Mauritius + 230Mayotte + 262Mexico + 52Micronesia + 691Moldova + 373Monaco + 377Mongolia + 976Montenegro + 382Montserrat + 1-664Morocco + 212Mozambique + 258Myanmar + 95Namibia + 264Nauru + 674Nepal + 977Netherlands + 31Netherlands Antilles + 599New Caledonia + 687New Zealand + 64Nicaragua + 505Niger + 227Nigeria + 234Niue + 683North Korea + 850Northern Mariana Islands + 1-670Norway + 47Oman + 968Pakistan + 92Palau + 680Palestine + 970Panama + 507Papua New Guinea + 675Paraguay + 595Peru + 51Philippines + 63Pitcairn + 64Poland + 48Portugal + 351Puerto Rico + 1-787Qatar + 974Republic of the Congo + 242Reunion + 262Romania + 40Russia + 7Rwanda + 250Saint Barthelemy + 590Saint Helena + 290Saint Kitts and Nevis + 1-869Saint Lucia + 1-758Saint Martin + 590Saint Pierre and Miquelon + 508Saint Vincent and the Grenadines + 1-784Samoa + 685San Marino + 378Sao Tome and Principe + 239Saudi Arabia + 966Senegal + 221Serbia + 381Seychelles + 248Sierra Leone + 232Singapore + 65Sint Maarten + 1-721Slovakia + 421Slovenia + 386Solomon Islands + 677Somalia + 252South Africa + 27South Korea + 82South Sudan + 211Spain + 34Sri Lanka + 94Sudan + 249Suriname + 597Svalbard and Jan Mayen + 47Swaziland + 268Sweden + 46Switzerland + 41Syria + 963Taiwan + 886Tajikistan + 992Tanzania + 255Thailand + 66Togo + 228Tokelau + 690Tonga + 676Trinidad and Tobago + 1-868Tunisia + 216Turkey + 90Turkmenistan + 993Turks and Caicos Islands + 1-649Tuvalu + 688U.S. Virgin Islands + 1-340Uganda + 256Ukraine + 380United Arab Emirates + 971United Kingdom + 44United States + 1Uruguay + 598Uzbekistan + 998Vanuatu + 678Vatican + 379Venezuela + 58Vietnam + 84Wallis and Futuna + 681Western Sahara + 212Yemen + 967Zambia + 260Zimbabwe + 263
Home No
Country Code Country CodeGuyana + 592Afghanistan + 93Albania + 355Algeria + 213American Samoa + 1-684Andorra + 376Angola + 244Anguilla + 1-264Antarctica + 672Antigua and Barbuda 1-268Argentina + 54Armenia + 374Aruba + 297Australia + 61Austria + 43Azerbaijan + 994Bahamas + 1-242Bahrain + 973Bangladesh + 880Barbados + 1-246Belarus + 375Belgium + 32Belize + 501Benin + 229Bermuda + 1-441Bhutan + 975Bolivia + 591Bonaire + 599Bosnia and Herzegovina + 387Botswana + 267Brazil + 55British Indian Ocean Territory + 246British Virgin Islands + 1-284Brunei + 673Bulgaria + 359Burkina Faso + 226Burundi + 257Cambodia + 855Cameroon + 237Canada + 1Cape Verde + 238Cayman Islands + 1-345Central African Republic + 236Chad + 235Chile + 56China + 86Christmas Island + 61Cocos Islands + 61Colombia + 57Comoros + 269Cook Islands + 682Costa Rica + 506Croatia + 385Cuba + 53Curacao + 599Cyprus + 357Czech Republic + 420Democratic Republic of the Congo + 243Denmark + 45Djibouti + 253Dominica + 1-767Dominican Republic + 1-809East Timor + 670Ecuador + 593Egypt + 20El Salvador + 503Equatorial Guinea + 240Eritrea + 291Estonia + 372Ethiopia + 251Falkland Islands + 500Faroe Islands + 298Fiji + 679Finland + 358France + 33French Polynesia + 689Gabon + 241Gambia + 220Georgia + 995Germany + 49Ghana + 233Gibraltar + 350Greece + 30Greenland + 299Grenada + 1-473Guam + 1-671Guatemala + 502Guernsey + 44-1481Guinea + 224Guinea-Bissau + 245Guyana + 592Haiti + 509Honduras + 504Hong Kong + 852Hungary + 36Iceland + 354India + 91Indonesia + 62Iran + 98Iraq + 964Ireland + 353Isle of Man + 44-1624Israel + 972Italy + 39Ivory Coast + 225Jamaica + 1-876Japan + 81Jersey + 44-1534Jordan + 962Kazakhstan + 7Kenya + 254Kiribati + 686Kosovo + 383Kuwait + 965Kyrgyzstan + 996Laos + 856Latvia + 371Lebanon + 961Lesotho + 266Liberia + 231Libya + 218Liechtenstein + 423Lithuania + 370Luxembourg + 352Macau + 853Macedonia + 389Madagascar + 261Malawi + 265Malaysia + 60Maldives + 960Mali + 223Malta + 356Marshall Islands + 692Mauritania + 222Mauritius + 230Mayotte + 262Mexico + 52Micronesia + 691Moldova + 373Monaco + 377Mongolia + 976Montenegro + 382Montserrat + 1-664Morocco + 212Mozambique + 258Myanmar + 95Namibia + 264Nauru + 674Nepal + 977Netherlands + 31Netherlands Antilles + 599New Caledonia + 687New Zealand + 64Nicaragua + 505Niger + 227Nigeria + 234Niue + 683North Korea + 850Northern Mariana Islands + 1-670Norway + 47Oman + 968Pakistan + 92Palau + 680Palestine + 970Panama + 507Papua New Guinea + 675Paraguay + 595Peru + 51Philippines + 63Pitcairn + 64Poland + 48Portugal + 351Puerto Rico + 1-787Qatar + 974Republic of the Congo + 242Reunion + 262Romania + 40Russia + 7Rwanda + 250Saint Barthelemy + 590Saint Helena + 290Saint Kitts and Nevis + 1-869Saint Lucia + 1-758Saint Martin + 590Saint Pierre and Miquelon + 508Saint Vincent and the Grenadines + 1-784Samoa + 685San Marino + 378Sao Tome and Principe + 239Saudi Arabia + 966Senegal + 221Serbia + 381Seychelles + 248Sierra Leone + 232Singapore + 65Sint Maarten + 1-721Slovakia + 421Slovenia + 386Solomon Islands + 677Somalia + 252South Africa + 27South Korea + 82South Sudan + 211Spain + 34Sri Lanka + 94Sudan + 249Suriname + 597Svalbard and Jan Mayen + 47Swaziland + 268Sweden + 46Switzerland + 41Syria + 963Taiwan + 886Tajikistan + 992Tanzania + 255Thailand + 66Togo + 228Tokelau + 690Tonga + 676Trinidad and Tobago + 1-868Tunisia + 216Turkey + 90Turkmenistan + 993Turks and Caicos Islands + 1-649Tuvalu + 688U.S. Virgin Islands + 1-340Uganda + 256Ukraine + 380United Arab Emirates + 971United Kingdom + 44United States + 1Uruguay + 598Uzbekistan + 998Vanuatu + 678Vatican + 379Venezuela + 58Vietnam + 84Wallis and Futuna + 681Western Sahara + 212Yemen + 967Zambia + 260Zimbabwe + 263
Work No
Country Code Country CodeGuyana + 592Afghanistan + 93Albania + 355Algeria + 213American Samoa + 1-684Andorra + 376Angola + 244Anguilla + 1-264Antarctica + 672Antigua and Barbuda 1-268Argentina + 54Armenia + 374Aruba + 297Australia + 61Austria + 43Azerbaijan + 994Bahamas + 1-242Bahrain + 973Bangladesh + 880Barbados + 1-246Belarus + 375Belgium + 32Belize + 501Benin + 229Bermuda + 1-441Bhutan + 975Bolivia + 591Bonaire +599Bosnia and Herzegovina + 387Botswana + 267Brazil + 55British Indian Ocean Territory + 246British Virgin Islands + 1-284Brunei + 673Bulgaria + 359Burkina Faso + 226Burundi + 257Cambodia + 855Cameroon + 237Canada + 1Cape Verde + 238Cayman Islands + 1-345Central African Republic + 236Chad + 235Chile + 56China + 86Christmas Island + 61Cocos Islands + 61Colombia + 57Comoros + 269Cook Islands + 682Costa Rica + 506Croatia + 385Cuba + 53Curacao + 599Cyprus + 357Czech Republic + 420Democratic Republic of the Congo + 243Denmark + 45Djibouti + 253Dominica + 1-767Dominican Republic + 1-809East Timor + 670Ecuador + 593Egypt + 20El Salvador + 503Equatorial Guinea + 240Eritrea + 291Estonia + 372Ethiopia + 251Falkland Islands + 500Faroe Islands + 298Fiji + 679Finland + 358France + 33French Polynesia + 689Gabon + 241Gambia + 220Georgia + 995Germany + 49Ghana + 233Gibraltar + 350Greece + 30Greenland + 299Grenada + 1-473Guam + 1-671Guatemala + 502Guernsey + 44-1481Guinea + 224Guinea-Bissau + 245Guyana + 592Haiti + 509Honduras + 504Hong Kong + 852Hungary + 36Iceland + 354India + 91Indonesia + 62Iran + 98Iraq + 964Ireland + 353Isle of Man + 44-1624Israel + 972Italy + 39Ivory Coast + 225Jamaica + 1-876Japan + 81Jersey + 44-1534Jordan + 962Kazakhstan + 7Kenya + 254Kiribati + 686Kosovo + 383Kuwait + 965Kyrgyzstan + 996Laos + 856Latvia + 371Lebanon + 961Lesotho + 266Liberia + 231Libya + 218Liechtenstein + 423Lithuania + 370Luxembourg + 352Macau + 853Macedonia + 389Madagascar + 261Malawi + 265Malaysia + 60Maldives + 960Mali + 223Malta + 356Marshall Islands + 692Mauritania + 222Mauritius + 230Mayotte + 262Mexico + 52Micronesia + 691Moldova + 373Monaco + 377Mongolia + 976Montenegro + 382Montserrat + 1-664Morocco + 212Mozambique + 258Myanmar + 95Namibia + 264Nauru + 674Nepal + 977Netherlands + 31Netherlands Antilles + 599New Caledonia + 687New Zealand + 64Nicaragua + 505Niger + 227Nigeria + 234Niue + 683North Korea + 850Northern Mariana Islands + 1-670Norway + 47Oman + 968Pakistan + 92Palau + 680Palestine + 970Panama + 507Papua New Guinea + 675Paraguay + 595Peru + 51Philippines + 63Pitcairn + 64Poland + 48Portugal + 351Puerto Rico + 1-787Qatar + 974Republic of the Congo + 242Reunion + 262Romania + 40Russia + 7Rwanda + 250Saint Barthelemy + 590Saint Helena + 290Saint Kitts and Nevis + 1-869Saint Lucia + 1-758Saint Martin + 590Saint Pierre and Miquelon + 508Saint Vincent and the Grenadines + 1-784Samoa + 685San Marino + 378Sao Tome and Principe + 239Saudi Arabia + 966Senegal + 221Serbia + 381Seychelles + 248Sierra Leone + 232Singapore + 65Sint Maarten + 1-721Slovakia + 421Slovenia + 386Solomon Islands + 677Somalia + 252South Africa + 27South Korea + 82South Sudan + 211Spain + 34Sri Lanka + 94Sudan + 249Suriname + 597Svalbard and Jan Mayen + 47Swaziland + 268Sweden + 46Switzerland + 41Syria + 963Taiwan + 886Tajikistan + 992Tanzania + 255Thailand + 66Togo + 228Tokelau + 690Tonga + 676Trinidad and Tobago + 1-868Tunisia + 216Turkey + 90Turkmenistan + 993Turks and Caicos Islands + 1-649Tuvalu + 688U.S. Virgin Islands + 1-340Uganda + 256Ukraine + 380United Arab Emirates + 971United Kingdom + 44United States + 1Uruguay + 598Uzbekistan + 998Vanuatu + 678Vatican + 379Venezuela + 58Vietnam + 84Wallis and Futuna + 681Western Sahara + 212Yemen + 967Zambia + 260Zimbabwe + 263
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Status* EmployedSelf EmployedStudent
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Bank/Institution
Name of Account
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Total
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Present Borrowing(s) Bank/Institution
Installment
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MONTHLY INCOME
MONTHLY EXPENSES
Income (Net)
Other Income
Details of other income:
Total Income $
Surplus $
Debt Service Ratio
Food
Telephone
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Car
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GBTI Credit Card
Payment (proposed)
Loan repayments
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Total Expenses $
Total Expense %
Assets/Liabilities
Assets
Amount $
Liabilities
Monthly Payments $
Cash-in-Hand
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Savings/Term Deposits
Credit Card(s)
Stock & Shares
Vehicle(s)
Personal Debt
Value of Property
Mortgage(s)
Investments
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Total Assets $
Total Liabilities $
Net Worth $
Branch
Reason for applying for GBTI VISA Credit Card
Personal Details
First Name
Surname
Salutation
MrMrsMs
Marital Status
DivorcedMarriedSingleWidowed
No of Dependants
Date of Birth (dd/mm/yy):
Place of Birth Country
Nationality
National Identification No
Contact Details
Home Address
Type of Residence FamilyOwnerParentsTenant
Name a contact person who we may contact in the event you are overseas:
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