CREDIT CARD APPLICATION (For existing Account holders)

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1 CREDIT CARD APPLICATION (For existing Account holders) Your Account Number Card Type Options Visa Platinum Cashback MasterCard Advance MasterCard Premier MasterCard Premier Black Personal Details Marital Status: Married - Family in UAE Married - Family outside UAE Single Widowed/Divorced/Separated Education: Graduate Limited/None Post Graduate Primary Professional Secondary/HighSchool Preferred language: Arabic English Number of dependents: More than 5 SCC applicable Yes No For office use IDENTIFICATION DETAILS If details are different from current HSBC UAE records, customer to update these details by visiting the branch of citizenship (as per passport) of residence Residence Visa Number Residence Visa Expiry Date Emirates ID Number - RESIDENCE ADDRESS If details are different from current HSBC UAE records, customer to update these details through Internet Banking or visiting the branch or staff to obtain filled Additional Account Services form Flat no/ Villa no/ Building Name/Street Name Area Emirate/City If time at address above was less than 3 years, previous address: Flat no/ Villa no/ Building Name/Street Name Area Emirate/City HOME COUNTRY ADDRESS House/flat no., street Area/City Postal/Zip Code

2 TELEPHONE AND CONTACT DETAILS name: Mobile Number with international code (00) - ( ) - (eg ) Residence Number (00) - ( ) - (eg ) Cod de Home contact number (00) - ( ) - (eg ) Address Code From time to time, HSBC may wish to send you details of new products and services, promotions and special offers. Please select your preferred method of contact. You may select more than one method of contact. Telephone Yes No Yes No Direct Mail Yes No SMS Yes No SUPPLEMENTARY CARDHOLDER APPLICANT DETAILS Supplementary Cardholder Applicant 1 Title Mr. Mrs. Miss Ms. Dr. Prof. Sh Sha First Name: Last Name: Date of birth: Gender: Male Female Name to appear on credit card Mobile Number Emirates ID Number - Limit* Shared limit Separate Limit If separate limit, limit to be assigned to Supplementary Card (in AED) Supplementary Cardholder Applicant 2 Title Mr. Mrs. Miss Ms. Dr. Prof. Sh Sha First Name: Last Name: Date of birth: Gender: Male Female Name to appear on credit card Mobile Number Emirates ID Number - Limit* Shared limit Separate Limit If separate limit, limit to be assigned to Supplementary Card (in AED) * Fees apply. Please refer to Schedule of Services & Tariffs on

3 EMPLOYMENT AND INCOME DETAILS If details have changed from existing records with HSBC UAE, relevant documents to be collected by member of staff Type of employment Salaried Student Housewife Self Employed Not Employed/Non-Resident Company/Employer name Industry Occupation Duration of service with this employer Years Months If salaried, monthly salary (AED) If self employed, 1) What is your annual business income in AED 2) What is your credit turnover in AED 3) What is your average balance in AED Office Telephone - (eg ) Office Address Building name/street address PO Box Emirate Abu Dhabi Ajman Al Ain Dubai Fujairah Ras Al Khaimah Sharjah Umm Al Quwain EXISTING FINANCIAL COMMITMENTS WITH HSBC AND OTHER BANK S CREDIT CARDS AND LOANS IN AED: Credit Limit on Credit Cards (in AED) Overdraft limits on accounts (in AED) Vehicle Loan repayments (monthly) Other Loan repayments (monthly) Set up auto debit Yes No (Should your application be sucessful, would you like to set up an instruction to automatically settle your card outstanding each month by debit to your account. Kindly note that a minimum 5% of outstanding balance needs to be settled each month) If yes, repayment option Minimum (5%) Partial Full (100%) Name as you would like it to appear on your Credit Card Set up Air Miles Card Yes No Do you already have an Air Miles Card? If you do, please enter the Air Miles Card number so that we can link it to your Credit Card. If you do not have an Air Miles Card, you will be automatically enrolled and will receive your Air Miles card within the next 15 working days. Not applicable for Visa Platinum Cashback Existing Air Miles card number Select Credit Card Payment Date Auto Debit Instructions* HSBC UAE Account number Payment Instruction: 5% 100% Others % * Will also be applicable for Separate Limit Supplementary Cards

4 Receive complimentary SMS alerts Yes No Receive SMS alerts when there is a debit transaction on your credit card. Declaration of Primary Card Applicant I hereby apply for the issue of an HSBC Card and declare that the information provided in this application is true and correct and authorise HSBC to verify this information from whatever sources that it may choose. I accept that HSBC is entitled in its absolute discretion to accept or reject an application without assigning any reason whatsoever. I acknowledge that the use of my HSBC Card and any Supplementary HSBC Card(s) issued on the card account will be subject to the HSBC Personal Banking General Terms and Conditions(UAE) and the HSBC Credit Card Agreement Terms accompanying the HSBC Card(s) available on (which may be amended from time to time at HSBC s sole discretion). I understand that by using the HSBC Card or Supplementary HSBC Card(s) I accept the HSBC Personal Banking General Terms and Conditions(UAE) and the HSBC Credit Card Agreement Terms and that I shall be liable, unconditionally, for any amounts outstanding on both my HSBC Card and any Supplementary HSBC Card(s). Where an application is made now or in the future, I hereby authorise HSBC to issue Supplementary HSBC Card(s) for use on my account to the person(s) named who is/are over 16 years of age and agree that you can provide relevant information to the Supplementary HSBC Cardholder about the account. I accept that any account(s) operated in conjunction with the HSBC Card(s) will be subject to the HSBC Personal Banking General Terms and Conditions(UAE) and the HSBC Credit Card Agreement Terms which govern the ATM facility as stated in the HSBC Personal Banking General Terms and Conditions(UAE) and the HSBC Credit Card Agreement Terms available on In addition to Section 7 of the HSBC Personal Banking General Terms and Conditions (UAE): I agree that HSBC may disclose my information to any third party in order to verify the information that I have provided to HSBC, including contacting my employer to verify my employment status and any other information in connection with my employment. I agree that HSBC can share information with credit reference agencies/bureaus and use information available from public sources to verify my identity and suitability for a Credit Card. I agree that when I apply for a Credit Card (or any other credit facility with HSBC) then as part of my application, HSBC may, on an ongoing basis, request reports from credit reference agencies/bureaus to assess my ability to meet my financial commitments without further consent from me. I understand that to request multiple reports from credit reference agencies/bureaus may negatively impact my credit score which may make it difficult for me to obtain credit in the future. I confirm that I have been made aware of the current benefits available in respect of my HSBC Card, including any free insurance benefits, and have been referred to the website for more information on such benefits, which may be amended from time to time at HSBC s discretion. Primary Card Applicant Signature Date: Declaration of Separate limit Supplementary Card Applicant(s) I, the HSBC Supplementary Card applicant acknowledge that the use of my Supplementary Card will be subject to the HSBC Personal Banking General Terms and Conditions(UAE) and the HSBC Credit Card Agreement Terms available on (which may be amended from time to time at HSBC s sole discretion) accompanying the Supplementary Card. I understand that by using the Supplementary Card I accept the HSBC Personal Banking General Terms and Conditions(UAE) and the HSBC Credit Card Agreement Terms available on Supplementary Card Applicant 1 Signature Date: Supplementary Card Applicant 2 Signature Date: Copyright. HSBC Bank Middle East Limited 2016 ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of HSBC Bank Middle East Limited. Issued by HSBC Bank Middle East Limited U.A.E Branch, P. O.Box 66, Dubai, U.A.E, regulated by the Central Bank of the U.A.E and lead regulated by the Dubai Financial Services Authority. V160802

5 Date: D D / MM / Y Y Y Y Branch: HSBC Visa Platinum Cashback Credit Card Customer Acknowledgement Form Customer Acknowledgment I/We agree that the information provided is true, accurate and complete. I/we confirm that I/we have been informed that by signing this customer acknowledgement form I/we accept and will be bound by the HSBC Personal Banking General Terms and Conditions (UAE), the HSBC Credit Card Agreement Terms (UAE), the Cashback Credit Card Terms and Conditions (UAE) and the Schedule of Services and Tariffs (as applicable), as amended from time to time, the latest version of which can be found at I/we confirm that I/we have been informed to read these terms and the tariff sheet I/We understand and accept that in relation to the HSBC Visa Platinum Cashback Credit Card, an annual fee applies as set out in the Schedule of Tariffs as amended from time to time available at I/We understand that the benefits and features are set out on and may be subject to change at any time at the Bank s discretion. Please ensure signature is within box provided in Black Ink only. Primary Credit Card Applicant: Supplementary Credit Card Applicant (1): Supplementary Credit Card Applicant (2): Supplementary Credit Card Applicant (3): Copyright. HSBC Bank Middle East Limited 2016 ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, on any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of HSBC Bank Middle East Limited. Issued by HSBC Bank Middle East Limited, U.A.E Branch, PO Box 66, Dubai, U.A.E, regulated by the Central Bank of the U.A.E and lead regulated by the Dubai Financial Services Authority. V160609

HSBC Premier Account Opening Application Form

August 2016 HSBC Premier Account Opening Application Form Copyright. HSBC Bank Middle East Limited 2016 ALL RIGHTS RESERVED. No part of this publication may be reproduced, stored in a retrieval system,