Debit Card Application

Personal Information

MDMEDICINE No.

Expiry Date

Title

Gender

First Name

Sur Name

Maiden Name

Father Name

Mother Name

Place of Birth

Date of Birth

Country of Birth *

Civil Register no. & Place

Nationality

ID no

Nationality Other

Passport no

Tax Identification Number

Country

Marital Status

No. of Children

No of Dependents

Name Appear on the Card

Type

Resident
Non Resident

Resident Type

Homeowner
Living with family
Tenant

Date you moved to this address

Home Addresss

Apt no

Floor

Building

Street

District

City

Caza

Country

Postal Code

P.O.Box

Phone no.

Mobile no.

Email Address

Employment Information

Country of Employment

Type of Employment *

Company Name

Employment Start Date

Professional Field / Industry

Job Title

Home Addresss

Apt no

Floor

Building

Street

District

City

Caza

Country

Phone No.

Mobile No.

Email Address

MAILING ADDRESS

I would like to receive mail at my *

Home Address
Business Address

FINANCIAL STATUS

Yearly Fixed Income (USD)

Yearly Fixed income

Monthly Variable Income

E-SERVICES

I want to subscribe to the following service(s) on my card under my full and sole responsibility without any liability whatsoever to Credit Libanais sal

E-Statement

I would like to receive an e-statement on the below e-mail address

Email Address

1

Email

Add Row

SMS Alerts

I would like to receive SMS alerts on my mobile phone/phones

Phone Numbers

1

Phone

Add Row

No Alert

I don’t want to receive SMS on my mobile, in this case I will remain solely and fully liable for all the transactions executed on my cards, consequently your bank shall not incur any liability whatsoever in this respect.

PHONE, EMAIL, FAX & INTERNET INSTRUCTIONS

Agree

I hereby acknowledge and consent that Credit Libanais sal has the right to apply future amendments to any of the above information when requested by me via phone, fax, e-mail or the internet. Furthermore, by signing this application, I declare that Credit Libanais sal shall have no responsibility or liability whatsoever in this respect and that I have the right, within 15 days of receiving my statement or any SMS alert, to object to any changes that I claim have not been requested personally by me or that display incorrect information.

DECLARATION & AUTHORIZATION

Agree *

I hereby certify that all information provided in this application is, to the best of my knowledge, true and accurate and I confirm that Credit Libanais sal has the right to file any legal action against me for any willful misstatements or omissions. Furthermore, by signing this application, I hereby confirm that I have read and approved without any reservations all the terms and conditions. I declare that this product suits my needs, requirements and financial capabilities and that I am aware of all its specifications, features and the risks that result and/or might result from signing this application.

Terms and Conditions *

I declare having received, read and approved the Key Facts Statement showing the card’s specifications and conditions. here By submitting this application I declare having received, read, and agreed to all the specifications and conditions mentioned.

Debit Card Application

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