Gold & Classic Application

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All Fields marked with * are Mandatory

CREDIT CARD REQUIRED: GBTI VISA GOLD - US$10,000 (Maximum) | GBTI VISA CLASSIC -
US$5,000 (Maximum)

CREDIT CARD REQUIRED

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*

PRINCIPAL APPLICANT

Branch*

Reason for applying for GBTI VISA Credit Card*

Customer CIF

How did you hear about this?*

Personal Details

First Name*

Middle Name

Surname*

No of Dependants*

Date of Birth (dd/mm/yy): *

Place of Birth Country*

Nationality*

National Identification No*

Date of issue

Passport No

Country*

Date of issue

Expiry Date

Drivers Licence No

Country

Date of issue

Expiry Date

Tax Payers Identification No

Contact Details

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 *

Home No

Country Code

Work No

Country Code

Mobile No*

Country Code

Fax No

Telephone details when overseas:

Country Code

Number

Name a contact person who we may contact in the event you are overseas:

Full Name

Full Address

Country Code

Home No

Country Code

Work No

Country Code

Mobile No

Email address

Confirm Email address

Relationship

Employment Details

Status*
EmployedSelf EmployedStudent

Other: Please state

Occupation*

Employers Name

Employers Address

City

No of years there

Monthly Salary/Income

Banking Information

Bank/Institution	Name of Account	Current Balance	Account Type


Total

Financial Information

Note: If section is not applicable put N/A in field

Present Borrowing(s) Bank/Institution	Current Balance	Installment	Arrears	Maturity Date




Total

Income/Expenses

MONTHLY INCOME	MONTHLY EXPENSES
Income (Net) Other Income Details of other income: Total Income $ Surplus $ Debt Service Ratio	Food Telephone Utilities Car Insurance Hire Purchase GBTI Credit Card Payment (proposed) Loan repayments Entertainment Other Total Expenses $ Total Expense %

MONTHLY INCOME

MONTHLY EXPENSES

Income (Net)

Other Income

Details of other income:

Total Income $

Surplus $

Debt Service Ratio

Food

Telephone

Utilities

Car

Insurance

Hire Purchase

GBTI Credit Card

Payment (proposed)

Loan repayments

Entertainment

Other

Total Expenses $

Total Expense %

Assets/Liabilities

Assets/Liabilities
Assets	Amount $	Liabilities	Monthly Payments $
Cash-in-Hand		Personal Loans
Savings/Term Deposits		Credit Card(s)
Stock & Shares		Hire Purchase
Vehicle(s)		Personal Debt
Value of Property		Mortgage(s)
Investments		Long-term debt
Other		Other
Total Assets $		Total Liabilities $
Net Worth $

CO-APPLICANT

Branch

Customer CIF

Reason for applying for GBTI VISA Credit Card

Personal Details

First Name

Middle Name

Surname

Salutation

MrMrsMs

Marital Status

DivorcedMarriedSingleWidowed

No of Dependants

Date of Birth (dd/mm/yy):

Place of Birth Country

Nationality

National Identification No

Date of issue

Passport No

Country

Date of issue

Expiry Date

Drivers Licence No

Country

Date of issue

Expiry Date

Tax Payers Identification No

Contact Details

Home Address

Mailing Address (if different from home address)

No of years there

Type of Residence FamilyOwnerParentsTenant

Other please state

Country Code

Home No

Country Code

Work No

Country Code

Mobile No

Country Code

Fax No

Email address

Confirm Email address

Telephone details when overseas:

Country Code

Number

Name a contact person who we may contact in the event you are overseas:

Full Name

Full Address

Country Code

Home No

Country Code

Work No

Country Code

Mobile No

Email address

Confirm Email address

Relationship

Employment Details

Status
EmployedSelfEmployedStudent

Other: Please state

Occupation

Employers Name

Employers Address

No of years there

Monthly Salary/Income

Banking Information

Account No

Account Class

Safe Deposit Box

Other VISA cards held